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Tozsin A, Ucmak H, Soyturk S, Aydin A, Gozen AS, Fahim MA, Güven S, Ahmed K. The Role of Artificial Intelligence in Medical Education: A Systematic Review. Surg Innov 2024:15533506241248239. [PMID: 38632898 DOI: 10.1177/15533506241248239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND To examine the artificial intelligence (AI) tools currently being studied in modern medical education, and critically evaluate the level of validation and the quality of evidence presented in each individual study. METHODS This review (PROSPERO ID: CRD42023410752) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A database search was conducted using PubMed, Embase, and Cochrane Library. Articles written in the English language between 2000 and March 2023 were reviewed retrospectively using the MeSH Terms "AI" and "medical education" A total of 4642 potentially relevant studies were found. RESULTS After a thorough screening process, 36 studies were included in the final analysis. These studies consisted of 26 quantitative studies and 10 studies investigated the development and validation of AI tools. When examining the results of studies in which Support vector machines (SVMs) were employed, it has demonstrated high accuracy in assessing students' experiences, diagnosing acute abdominal pain, classifying skilled and novice participants, and evaluating surgical training levels. Particularly in the comparison of surgical skill levels, it has achieved an accuracy rate of over 92%. CONCLUSION AI tools demonstrated effectiveness in improving practical skills, diagnosing diseases, and evaluating student performance. However, further research with rigorous validation is required to identify the most effective AI tools for medical education.
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Affiliation(s)
- Atinc Tozsin
- Department of Urology, Trakya University School of Medicine, Edirne, Turkey
| | - Harun Ucmak
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Selim Soyturk
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Maha Al Fahim
- Medical Education Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Selcuk Güven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
- Khalifa University, Abu Dhabi, UAE
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Naghavi AO, Bryant JM, Kim Y, Weygand J, Redler G, Sim AJ, Miller J, Coucoules K, Michael LT, Gloria WE, Yang G, Rosenberg SA, Ahmed K, Bui MM, Henderson-Jackson EB, Lee A, Lee CD, Gonzalez RJ, Feygelman V, Eschrich SA, Scott JG, Torres-Roca J, Latifi K, Parikh N, Costello J. Habitat escalated adaptive therapy (HEAT): a phase 2 trial utilizing radiomic habitat-directed and genomic-adjusted radiation dose (GARD) optimization for high-grade soft tissue sarcoma. BMC Cancer 2024; 24:437. [PMID: 38594603 PMCID: PMC11003059 DOI: 10.1186/s12885-024-12151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/20/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Soft tissue sarcomas (STS), have significant inter- and intra-tumoral heterogeneity, with poor response to standard neoadjuvant radiotherapy (RT). Achieving a favorable pathologic response (FPR ≥ 95%) from RT is associated with improved patient outcome. Genomic adjusted radiation dose (GARD), a radiation-specific metric that quantifies the expected RT treatment effect as a function of tumor dose and genomics, proposed that STS is significantly underdosed. STS have significant radiomic heterogeneity, where radiomic habitats can delineate regions of intra-tumoral hypoxia and radioresistance. We designed a novel clinical trial, Habitat Escalated Adaptive Therapy (HEAT), utilizing radiomic habitats to identify areas of radioresistance within the tumor and targeting them with GARD-optimized doses, to improve FPR in high-grade STS. METHODS Phase 2 non-randomized single-arm clinical trial includes non-metastatic, resectable high-grade STS patients. Pre-treatment multiparametric MRIs (mpMRI) delineate three distinct intra-tumoral habitats based on apparent diffusion coefficient (ADC) and dynamic contrast enhanced (DCE) sequences. GARD estimates that simultaneous integrated boost (SIB) doses of 70 and 60 Gy in 25 fractions to the highest and intermediate radioresistant habitats, while the remaining volume receives standard 50 Gy, would lead to a > 3 fold FPR increase to 24%. Pre-treatment CT guided biopsies of each habitat along with clip placement will be performed for pathologic evaluation, future genomic studies, and response assessment. An mpMRI taken between weeks two and three of treatment will be used for biological plan adaptation to account for tumor response, in addition to an mpMRI after the completion of radiotherapy in addition to pathologic response, toxicity, radiomic response, disease control, and survival will be evaluated as secondary endpoints. Furthermore, liquid biopsy will be performed with mpMRI for future ancillary studies. DISCUSSION This is the first clinical trial to test a novel genomic-based RT dose optimization (GARD) and to utilize radiomic habitats to identify and target radioresistance regions, as a strategy to improve the outcome of RT-treated STS patients. Its success could usher in a new phase in radiation oncology, integrating genomic and radiomic insights into clinical practice and trial designs, and may reveal new radiomic and genomic biomarkers, refining personalized treatment strategies for STS. TRIAL REGISTRATION NCT05301283. TRIAL STATUS The trial started recruitment on March 17, 2022.
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Affiliation(s)
- Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
| | - J M Bryant
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Youngchul Kim
- Department of Bioinformatics and Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Joseph Weygand
- Department of Radiation Oncology and Applied Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Gage Redler
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Austin J Sim
- Department of Radiation Oncology, James Cancer Hospital, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Justin Miller
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kaitlyn Coucoules
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lauren Taylor Michael
- Clinical Trials Office, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Warren E Gloria
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - George Yang
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Stephen A Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kamran Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Marilyn M Bui
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Andrew Lee
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Caitlin D Lee
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ricardo J Gonzalez
- Department of Sarcoma, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Vladimir Feygelman
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Steven A Eschrich
- Department of Bioinformatics and Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jacob G Scott
- Translational Hematology and Oncology Research, Radiation Oncology Department, Cleveland Clinic, Cleveland, OH, USA
| | - Javier Torres-Roca
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kujtim Latifi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Nainesh Parikh
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - James Costello
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Erol E, Ecer G, Kiremit MC, Gokce Mİ, Balasar M, Sarikaya AF, Babayigit M, Karaarslan UC, Aksoy EI, Sarica K, Ahmed K, Güven S. Multicentric evaluation of high and low power lasers on RIRS success using propensity score analysis. Urolithiasis 2024; 52:32. [PMID: 38340151 PMCID: PMC10858819 DOI: 10.1007/s00240-024-01535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
In this study, we aimed to evaluate the effect of HPL on different parameters by different centers and urologists. While doing this, we evaluated different parameters by comparing HPL(High Power laser) and LPL(Low-power laser). This is an observational, retrospective, comparative, multicentric study of prospectively organised database. A total of 217 patients who underwent RIRS for kidney stones smaller than 2 cm in three different centers were included in the study. The patients were divided into two groups; LPL used (Group1, n:121 patients) and HPL used (Group2, n:96). Propensity score matching was done in the data analysis part. After matching, a total of 192 patients, 96 patients in both groups, were evaluated. There was no difference between the groups regarding age, gender, stone side, and stone location. The stone-free rate on the first day was 80.3% in Group 1, it was 78.1% in Group 2 (p = 0.9). In the third month, it was 90.7% in Group 1 and 87.5% in Group 2 (p:0.7).Hospitalization duration was significantly higher in Group 1. (2.35 ± 2.27 days vs. 1.42 ± 1.10 days; p < 0.001).The operation duration was 88.70 ± 29.72 min in Group1 and 66.17 ± 41.02 min in Group2 (p < 0.001). The fluoroscopy time (FT) was 90.73 ± 4.79 s in Group 1 and 50.78 ± 5.64 s in Group 2 (p < 0.001). Complications according to Clavien Classification, were similar between the groups(p > 0.05). According to our study similar SFR and complication rates were found with HPL and LPL. In addition, patients who used HPL had lower operation time, hospital stay, and fluoroscopy time than the LPL group. Although high-power lasers are expensive in terms of cost, they affect many parameters and strengthen the hand of urologists thanks to the wide energy and frequency range they offer.
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Affiliation(s)
- Eren Erol
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gokhan Ecer
- Department of Urology, Konya State Hospital, Konya, Turkey
| | - Murat Can Kiremit
- Department of Urology, School of Medicine, Koc University, Istanbul, Turkey
| | - Mehmet İlker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Balasar
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Muammer Babayigit
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | | | - Elif Ipek Aksoy
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Kemal Sarica
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Kamran Ahmed
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
- Khalifa University, Abu Dhabi, United Arab Emirates
- MRC Centre for Transplantation, King's College London, London, UK
| | - Selçuk Güven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey.
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Ahmed K, Thornton M, Taylor SJG. Mechanical load applied by Intraosseous Transcutaneous Amputation Prosthesis (ITAP) during walking on level and sloped treadmill: A case study. Med Eng Phys 2024; 124:104097. [PMID: 38418026 DOI: 10.1016/j.medengphy.2023.104097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 03/01/2024]
Abstract
This proof of concept study presents a method to collect and analyse kinetic data from one participant with a transfemoral amputation fitted with a percutaneous osseointegrated implant walking on a level and sloped treadmill. We describe the construction of and results from a bespoke wireless six axis load cell built into one participant's prosthetic assembly. The load cell does not clinically compromise the participant in any way and is an initial milestone in the development of a light-weight wireless load cell for use with percutaneous osseointegrated implants. In this case, it is the first time that kinetic data from a participant fitted with an Intraosseous Transcutaneous Amputation Prosthesis has been published. We propose that the data can be used to model the load transfer to the host bone, with several clinically significant applications. The raw dynamic data are made available and quasi-static load cases for each functional phase of gait are presented. Peak forces obtained in the medio-lateral (X), cranio-caudal (Y) and antero-posterior (Z) axes over level ground respectively were -243.8 N (0.24 BW), 1321.5 N (1.31 BW) and -421.8 N (0.42 BW); uphill were -141.0 N (0.14 BW), 1604.2 N (1.59 BW), -498.1 N (0.49 BW); downhill were -206.0 N (0.20 BW), 1103.9 N (1.09 BW), -547.2 N (0.54 BW). The kinetics broadly followed able bodied gait patterns with some gait strategies consistent in participants with other implant designs or prosthetic socket connections, for example offloading the artificial limb downhill.
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Affiliation(s)
- K Ahmed
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK; Center for Bionics and Pain Research, Mölndals Sjukhus, 431 30 Sweden.
| | - M Thornton
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK; Motor Learning Laboratory, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - S J G Taylor
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Din SZU, Ahmed K, Rengasamy KR, Gul N, Ahmad I. Re: Efficacy of photodynamic therapy in cutaneous leishmaniasis: A systematic review. Photodiagnosis Photodyn Ther 2024; 45:103957. [PMID: 38161038 DOI: 10.1016/j.pdpdt.2023.103957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/07/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Syed Zaheer Ud Din
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China
| | - Kamran Ahmed
- Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Kannan Rr Rengasamy
- Laboratory of Natural Products and Medicinal Chemistry (LNPMC), Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, Chennai 602107, India
| | - Neelam Gul
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan.
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Subbaraman B, Ahmed K, Heller M, Essary AC, Patel VL, Wang D. Evaluation of a Patient Decision Aid for Refractive Eye Surgery. Appl Clin Inform 2024; 15:75-84. [PMID: 38065557 DOI: 10.1055/a-2224-8000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND We developed a prototype patient decision aid, EyeChoose, to assist college-aged students in selecting a refractive surgery. EyeChoose can educate patients on refractive errors and surgeries, generate evidence-based recommendations based on a user's medical history and personal preferences, and refer patients to local refractive surgeons. OBJECTIVES We conducted an evaluative study on EyeChoose to assess the alignment of surgical modality recommendations with a user's medical history and personal preferences, and to examine the tool's usefulness and usability. METHODS We designed a mixed methods study on EyeChoose through simulations of test cases to provide a quantitative measure of the customized recommendations, an online survey to evaluate the usefulness and usability, and a focus group interview to obtain an in-depth understanding of user experience and feedback. RESULTS We used stratified random sampling to generate 245 test cases. Simulated execution indicated EyeChoose's recommendations aligned with the reference standard in 243 (99%). A survey of 55 participants with 16 questions on usefulness, usability, and general impression showed that 14 questions recorded more than 80% positive responses. A follow-up focus group with 10 participants confirmed EyeChoose's useful features of patient education, decision assistance, surgeon referral, as well as good usability with multimedia resources, visual comparison among the surgical modalities, and the overall aesthetically pleasing design. Potential areas for improvement included offering nuances in soliciting user preferences, providing additional details on pricing, effectiveness, and reversibility of surgeries, expanding the function of surgeon referral, and fixing specific usability issues. CONCLUSION The initial evaluation of EyeChoose suggests that it could provide effective patient education, generate appropriate recommendations, connect to local refractive surgeons, and demonstrate good system usability in a test environment. Future research is required to enhance the system functions, fully implement and evaluate the tool in naturalistic settings, and examine the findings' generalizability to other populations.
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Affiliation(s)
- Bhavani Subbaraman
- College of Health Solutions, Arizona State University, Tempe, Arizona, United States
| | - Kamran Ahmed
- College of Health Solutions, Phoenix Children's Hospital, Phoenix, Arizona, United States
| | - Matthew Heller
- College of Health Solutions, Eye Doctors of Arizona, Phoenix, Arizona, United States
| | - Alison C Essary
- College of Health Solutions, Arizona State University, Tempe, Arizona, United States
| | - Vimla L Patel
- College of Health Solutions, Arizona State University, Tempe, Arizona, United States
| | - Dongwen Wang
- College of Health Solutions, Arizona State University, Tempe, Arizona, United States
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Chahal B, Aydin A, Ahmed K. Virtual reality vs. physical models in surgical skills training. An update of the evidence. Curr Opin Urol 2024; 34:32-36. [PMID: 37962178 PMCID: PMC10715699 DOI: 10.1097/mou.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW Simulation is a key component of surgical training, enabling trainees to develop their skills in a safe environment. With simulators broadly grouped into physical models and virtual-reality (VR) simulators, it is important to evaluate the comparative effectiveness of the simulator types in terms of validity as well as cost. The review aims to compare the benefits and drawbacks of novel VR and physical simulators within the broader themes of endourology, laparoscopic and robotic operations, and other urological procedures. RECENT FINDINGS Key benefits of bench models include their comparatively lower cost, easy access and provision of haptic feedback, whereas VR simulators are generally self-sufficient, reusable and enable skills of haemostasis to be practised. The advent of perfused 3D printed simulators across a range of urological procedures may replace cadavers as the traditional gold-standard simulation modality. SUMMARY Although possessing differing strengths and downsides, VR and physical simulators when used together can have an additive effect due to skill transferability across the platforms. Further comparative studies are required to directly quantify the differences between physical models and VR simulators in terms of performance metrics and cost-effectiveness. There is lack of validated VR simulators for open and reconstructive procedures.
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Affiliation(s)
- Baldev Chahal
- MRC Centre for Transplantation, Guy's Hospital, King's College London
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London
- Khalifa University
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Parry E, Ahmed K, Evans S, Guest E, Klaire V, Koodaruth A, Labutale P, Matthews D, Lampitt J, Pickavance G, Sidhu M, Warren K, Singh B. GP assessment of unmet need in a complex multimorbid population using a data-driven and clinical triage system: a prospective cohort study. BJGP Open 2023; 7:BJGPO.2023.0078. [PMID: 37385665 DOI: 10.3399/bjgpo.2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Patients with unmet healthcare needs are more likely to access unscheduled care. Identifying these patients through data-driven and clinical risk stratification for active case management in primary care can help address patient need and reduce demand on acute services. AIM To determine how a proactive digital healthcare system can be used to undertake comprehensive needs analysis of patients at risk of unplanned admission and mortality. DESIGN & SETTING Prospective cohort study of six general practices in a deprived UK city. METHOD To identify those with unmet needs, the study's population underwent digitally-driven risk stratification into Escalated and Non-escalated groups using seven risk factors. The Escalated group underwent further stratification using GP clinical assessment into Concern and No concern groups. The Concern group underwent Unmet Needs Analysis (UNA). RESULTS From 24 746 patients, 516 (2.1%) were triaged into the Concern group and 164 (0.7%) underwent UNA. These patients were more likely to be older (t = 4.69, P<0.001), female (X2 = 4.46, P<0.05), have a Patients At Risk of Re-hospitalisation (PARR) score ≥80 (X2 = 4.31, P<0.05), be a nursing home resident (X2 = 6.75, P<0.01), or on an end-of-life (EOL) register (X2 = 14.55, P<0.001). Following UNA, 143 (87.2%) patients had further review planned or were referred for further input. The majority of patients had four domains of need. In those who GPs would not be surprised if they died within the next few months, n = 69 (42.1%) were not on an EOL register. CONCLUSION This study showed how an integrated, patient-centred, digital care system working with GPs can highlight and implement resources to address the escalating care needs of complex individuals.
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Affiliation(s)
- Emma Parry
- School of Medicine, Keele University, Staffordshire, UK
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Simon Evans
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Vijay Klaire
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | | | - Dawn Matthews
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Jonathan Lampitt
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Mona Sidhu
- Lee Road Medical Practice, Wolverhampton, UK
| | - Kate Warren
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- The City of Wolverhampton Council, Wolverhampton, UK
| | - Baldev Singh
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- University of Wolverhampton, School of Medicine and Clinical Practice, Faculty of Science and Engineering, Wolverhampton, UK
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Guldibi F, Altunhan A, Aydın A, Sonmez MG, Çakır ÖO, Balasar M, Guven S, Ahmed K. What is the effect of laser anatomical endoscopic enucleation of the prostate on the ejaculatory functions? A systematic review. World J Urol 2023; 41:3493-3501. [PMID: 37921935 DOI: 10.1007/s00345-023-04660-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/21/2023] [Indexed: 11/05/2023] Open
Abstract
INTRODUCTION Laser anatomical endoscopic enucleation of the prostate (LAEEP) has emerged as a promising new approach in endoscopic surgery for BPH. LAEEP could still result in ejaculatory dysfunction. AIM This systematic review aimed to examine the impact of LAEEP on male ejaculatory functions. METHODS The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and 15 records were included. Outcomes of interest included ejaculatory dysfunction (retrograde ejaculation, painful ejaculation, etc.) and validated questionnaire scores. The quality of studies included in the systematic review was determined using QUADAS scoring. RESULTS We retrieved data for 1877 men in 15 clinical studies investigating LAEEP surgery and reporting EjD rates. While only three of the obtained studies were on thulium fiber (ThuLEP), the rest were on holmium (HoLEP). The definition of "Ejaculatory Dysfunction" was not standardized, but in most works, it is referred to as retrograde ejaculation (RE). There were no data on the relationship between other LAEEP techniques and ejaculation functions. The authors compared the outcomes of used standard laser enucleation techniques with the modified techniques. The RE rate in LAEEP was 62.1 ± 25.1%, 71.3 ± 16.1% in standard techniques, and 27.2 ± 18.1% in ejaculation-preserving modified techniques (p < 0.001). CONCLUSION This review demonstrated that ejaculation-preserving techniques, i.e., modified techniques are superior to standard techniques. Studies have also shown that ejaculatory dysfunction rates gradually decrease with long-term follow-ups. Future well-designed studies could further investigate the ejaculation-preserving modification of LAEEP techniques and how they impact EjD rates and other sexual function outcomes.
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Affiliation(s)
- Furkan Guldibi
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | - Abdullah Altunhan
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | | | - Mehmet Giray Sonmez
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | - Ömer Onur Çakır
- Department of Urology, King's College Hospitals, London, UK
- MRC Centre for Transplantation, King's College London, Guy's Hospital Campus, London, UK
| | - Mehmet Balasar
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | - Selcuk Guven
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey.
| | - Kamran Ahmed
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
- Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Khalifa University, Abu Dhabi, UAE
- Department of Urology, King's College Hospitals, London, UK
- MRC Centre for Transplantation, King's College London, Guy's Hospital Campus, London, UK
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Luong HN, Ballan W, Ahmed K. Endogenous Stromal Keratitis Due to Coccidioidomycosis. Pediatr Infect Dis J 2023; 42:e497-e498. [PMID: 37670466 DOI: 10.1097/inf.0000000000004099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Affiliation(s)
- Hanna N Luong
- Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Wassim Ballan
- Department of Infectious Diseases, Phoenix Children's Hospital, Phoenix, Arizona
| | - Kamran Ahmed
- Department of Ophthalmology, Phoenix Children's Hospital, Phoenix, Arizona
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11
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Rodriguez A, Ahmed K, Tiwari N, Ramasubramanian A. Orbital cellulitis with panophthalmitis and scleral necrosis - a case report. BMC Ophthalmol 2023; 23:452. [PMID: 37957590 PMCID: PMC10641989 DOI: 10.1186/s12886-023-03193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Orbital cellulitis is common in young children and is often secondary to coexisting sinus disease. Coexisting orbital cellulitis and panophthalmitis is a rare clinical event and usually occurs secondary to trauma or from an endogenous source. CASE PRESENTATION A febrile 2-year-old male presented with periorbital inflammation and exudative retinal detachment. Imaging showed acute sinusitis and extensive orbital cellulitis. Because of progressive scleral thinning, the patient underwent enucleation. CONCLUSION We present a case of concurrent orbital cellulitis, panophthalmitis, and scleral necrosis in an immunocompetent pediatric patient. Timely intervention is important to prevent life threatening complications with the rare occurrence of coexistent orbital cellulitis and panophthalmitis.
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Affiliation(s)
- Aurora Rodriguez
- Phoenix Children's Hospital, 1920 E Cambridge Ave, 85,006-1464, Phoenix, AZ, United States of America
| | - Kamran Ahmed
- Phoenix Children's Hospital, 1920 E Cambridge Ave, 85,006-1464, Phoenix, AZ, United States of America
| | - Nishant Tiwari
- Phoenix Children's Hospital, 1920 E Cambridge Ave, 85,006-1464, Phoenix, AZ, United States of America
| | - Aparna Ramasubramanian
- Phoenix Children's Hospital, 1920 E Cambridge Ave, 85,006-1464, Phoenix, AZ, United States of America.
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12
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Vyas N, Brunckhorst O, Fanshawe JB, Stewart R, Dasgupta P, Ahmed K. Prognostic factors for mental wellbeing in prostate cancer: A systematic review and meta-analysis. Psychooncology 2023; 32:1644-1659. [PMID: 37789603 PMCID: PMC10946963 DOI: 10.1002/pon.6225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES To evaluate the evidence base for patient, oncological, and treatment prognostic factors associated with multiple mental wellbeing outcomes in prostate cancer patients. METHODS We performed a literature search of MEDLINE, EMBASE, and CINAHL databases including studies evaluating patient, oncological, or treatment factors against one of five mental wellbeing outcomes; depression, anxiety, fear of cancer recurrence, masculinity, and body image perception. Data synthesis included a random effects meta-analysis for the prognostic effect of individual factors if sufficient homogenous data was available, with a structured narrative synthesis where this was not possible. RESULTS A final 62 articles were included. Older age was associated with a reducing odds of depression (OR 0.97, p = 0.04), with little evidence of effect for other outcomes. Additionally, baseline mental health status was related to depression and increasing time since diagnosis was associated with reducing fear of recurrence, albeith with low certainty of evidence. However, few other patient or oncological factors demonstrated any coherent relationship with any wellbeing outcome. Androgen deprivation therapy was associated with increased depression (HR 1.65, 95% CI 1.41-1.92, p < 0.01) and anxiety, however, little difference was seen between other treatment options. Overall, whilst numerous factors were identified, most were evaluated by single studies with few evaluating masculinity and body image outcomes. CONCLUSION We highlight the existing evidence for prognostic factors in mental wellbeing outcomes in prostate cancer, allowing us to consider high-risk groups of patients for preventative and treatment measures. However, the current evidence is heterogenous with further work required exploring less conclusive factors and outcomes.
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Affiliation(s)
- Neel Vyas
- MRC Centre for TransplantationGuy's Hospital CampusKing's College LondonKing's Health PartnersLondonUK
| | - Oliver Brunckhorst
- MRC Centre for TransplantationGuy's Hospital CampusKing's College LondonKing's Health PartnersLondonUK
| | - Jack B. Fanshawe
- Urology CentreGuy's and St. Thomas' NHS Foundation TrustKing's Health Partners LondonLondonUK
| | - Robert Stewart
- King's College London Institute of Psychiatry, Psychology and NeuroscienceLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Prokar Dasgupta
- MRC Centre for TransplantationGuy's Hospital CampusKing's College LondonKing's Health PartnersLondonUK
- Urology CentreGuy's and St. Thomas' NHS Foundation TrustKing's Health Partners LondonLondonUK
| | - Kamran Ahmed
- MRC Centre for TransplantationGuy's Hospital CampusKing's College LondonKing's Health PartnersLondonUK
- Department of UrologySheikh Khalifa Medical CityAbu DhabiUAE
- Khalifa UniversityAbu DhabiUAE
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13
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Shoaib MH, Sikandar M, Yousuf RI, Parkash M, Kazmi SJH, Ahmed FR, Ahmed K, Saleem MT, Zaidi SH. Graduate and postgraduate educational challenges during the COVID-19 pandemic period: its impact and innovations-a scoping review. Syst Rev 2023; 12:195. [PMID: 37833820 PMCID: PMC10571448 DOI: 10.1186/s13643-023-02359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has transformed the global view of education, including graduate and postgraduate education making the development of an alternative approach in times of social isolation an academic imperative. The present review aims to investigate the challenges experienced among undergraduate and postgraduate education and the strategies adopted to address these challenges during the pandemic. METHOD The preferred reporting items for the systematic review and meta-analyses extension for Scoping Reviews (PRISMA-ScR) were followed. The aim was to include journal articles published in the English language that discussed the influence of the pandemic on educational processes and applied innovative approaches as a solution to educational challenges. From January to August 2020, PubMed, EMBASE, and Google Scholar were searched for articles, yielding 10,019 articles. Two groups of authors examined the retrieved articles separately to avoid any risk of bias. The title and abstract of the articles were used for scrutiny, followed by full-text screening based on the established inclusion and exclusion criteria. The facts and findings of the studies were also discussed based on per capita income, literacy rate, and Internet accessibility. RESULTS Thirty of the obtained articles were included in the study. The selected articles were from North and South/Latin America, Asia & Pacific, South Africa, and Europe regions. Nineteen of the selected articles dealt with undergraduate education, ten with postgraduate, and one with both groups. The affordability of digital devices and the availability of Internet services were the major challenges for low- and middle-income economies. The ZOOM platform has been adopted by more than 90% of the education systems. CONCLUSION Means of communication, including visual media, digitized content, and other web-based platforms, have been recognized as efficient learning and training tools, but have not been fully accessible for mass application and use due to the lack of availability of resources, their cost, and insufficient training among the users. In light of this review, it is suggested that harmonized and collaborative efforts should be made to develop cost-effective and user-friendly tools to overcome the current challenges and prevent future educational crises. SYSTEMIC REVIEW REGISTRATION The review was not registered.
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Affiliation(s)
- Muhammad Harris Shoaib
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan.
| | - Muhammad Sikandar
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Rabia Ismail Yousuf
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Monica Parkash
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Syed Jamil Hassan Kazmi
- Department of Geography, Faculty of Science, University of Karachi, Karachi, 75270, Pakistan
| | - Farrukh Rafiq Ahmed
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Kamran Ahmed
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Muhammad Talha Saleem
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Syeda Hina Zaidi
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
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Fanshawe JB, Wai-Shun Chan V, Asif A, Ng A, Van Hemelrijck M, Cathcart P, Challacombe B, Brown C, Popert R, Elhage O, Ahmed K, Brunckhorst O, Dasgupta P. Decision Regret in Patients with Localised Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2023; 6:456-466. [PMID: 36870852 DOI: 10.1016/j.euo.2023.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
CONTEXT Treatment choice for localised prostate cancer remains a significant challenge for patients and clinicians, with uncertainty over decisions potentially leading to conflict and regret. There is a need to further understand the prevalence and prognostic factors of decision regret to improve patient quality of life. OBJECTIVE To generate the best estimates for the prevalence of significant decision regret localised prostate cancer patients, and to investigate prognostic patient, oncological, and treatment factors associated with regret. EVIDENCE ACQUISITION We performed a systematic search of MEDLINE, Embase, and PsychINFO databases including studies evaluating the prevalence or patient, treatment, or oncological prognostic factors in localised prostate cancer patients. A pooled prevalence of significant regret was calculated with the formal prognostic factor evaluation conducted per factor identified. EVIDENCE SYNTHESIS Significant decision regret was present in a pooled 20% (95% confidence interval 16-23) of patients across 14 studies and 17883 patients. This was lower in active surveillance (13%), with little difference between those who underwent radiotherapy (19%) and those who underwent prostatectomy (18%). Evaluation of individual prognostic factors demonstrated higher regret in those with poorer post-treatment bowel, sexual, and urinary function; decreased involvement in the decision-making process; and Black ethnicity. However, evidence remains conflicting, with low or moderate certainty of findings. CONCLUSIONS A significant proportion of men experience decision regret after a localised prostate cancer diagnosis. Monitoring those with increased functional symptoms and improving patient involvement in the decision-making process through education and decision aids may reduce regret. PATIENT SUMMARY We looked at how common regret in treatment decisions is after treatment for early-stage prostate cancer and factors linked with this. We found that one in five regret their decision, with those who had experienced side effects or were less involved in the decision-making process more likely to have regret. By addressing these, clinicians could reduce regret and improve quality of life.
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Affiliation(s)
| | - Vinson Wai-Shun Chan
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK; Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Aqua Asif
- Division of Surgery and Interventional Sciences, University College London, London, UK; Royal Surrey NHS Foundation Trust, Surrey, UK
| | - Alexander Ng
- Division of Surgery and Interventional Sciences, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Paul Cathcart
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ben Challacombe
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Christian Brown
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Rick Popert
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Oussama Elhage
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; School of Immunology and Microbial Sciences, King's College London, King's Health Partners, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK; Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Khalifa University, Abu Dhabi, United Arab Emirates
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Prokar Dasgupta
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
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15
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Khursheed N, Ahsan Q, Rattani S, Fatima M, Raza A, Tariq S, Mustafa T, Ahmed K, Iqbal S, Zulfiqar S, Ahmed SM, Fatima G, Akbar Khan S, Ullah F, Ahmed RA, Jamal S. Point prevalence probing of antimicrobial prescription patterns from a developing country. Expert Rev Anti Infect Ther 2023:1-8. [PMID: 37712527 DOI: 10.1080/14787210.2023.2259098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/04/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Irrational use of antibiotics intensifies resistance and jeopardizes advances made in modern medicine. We aimed to conduct a baseline gap analysis survey on antibiotic prescription practices across Pakistan. RESEARCH DESIGN AND METHODS This multi-centered cross-sectional survey was conducted at six public sector tertiary care hospitals from February 2021 to March 2021. Data related to various variables including hospital infrastructure, policies and practices, monitoring and feedback, and epidemiological, clinical, and antibiotic prescription for surveyed patients was collected using World Health Organization (WHO) Point Prevalence Survey (PPS) methodology. RESULTS In a survey of 837 inpatients, 78.5% were prescribed antibiotics. Most commonly prescribed antimicrobial was ceftriaxone (21.7%), followed by metronidazole (17.3%), cefoperazone-sulbactam (8.4%), amoxicillin-clavulanate (6.3%), and piperacillin/tazobactam (5.9%). Surgical prophylaxis (36.7%) and community-acquired infections (24.7%) were the main reasons for antibiotic prescriptions. Single antibiotics were given to 46.7% of patients, 39.9% received a combination of two antibiotics, and 12.5% were prescribed three or more antibiotics. Among six hospitals surveyed, two had drug and therapeutic committees, three had infection prevention and control committees, and one had an antibiotic formulary. CONCLUSION Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasize the importance of expanding antimicrobial stewardship programs among hospitals. Mentoring clinical teams could help rationalize antimicrobial use.
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Affiliation(s)
- Nazia Khursheed
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Qadeer Ahsan
- DAI - Fleming Fund Country Grant, Islamabad, Pakistan
| | - Salima Rattani
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Madeeha Fatima
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Ali Raza
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Saba Tariq
- DAI - Fleming Fund Country Grant, Islamabad, Pakistan
| | | | - Kamran Ahmed
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Sadia Iqbal
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | | | | | - Ghulam Fatima
- Dr Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan
| | | | - Farman Ullah
- Provincial Head Quarter Hospital, Gilgit, Pakistan
| | | | - Saba Jamal
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
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16
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Hayat S, Brunckhorst O, Alnajjar HM, Cakir OO, Muneer A, Ahmed K. A systematic review of non-surgical management in Peyronie's disease. Int J Impot Res 2023; 35:523-532. [PMID: 36289392 PMCID: PMC10499596 DOI: 10.1038/s41443-022-00633-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022]
Abstract
The efficacy of many non-surgical treatments for Peyronie's disease is unclear. This systematic review aims to critically assess the currently available options and provide a recommendation for treatment based on this. A systematic literature search utilising the Medline (Pubmed), Embase, global health and Cochrane library databases was conducted up to May 2021. All randomised controlled trials assessing non-surgical treatment modalities for Peyronie's Disease were included. Individual study risk of bias was evaluated using the Cochrane tool and GRADE was used to assess evidence strength. Outcome measures were the change in penile curvature (degrees), plaque size (volume or size), International Index of Erectile Function score, pain scores and change in penile length. Prospero registration number: CRD42017064618. Amongst the 5549 articles identified, 41 studies (42 reports) were included. Seven different oral treatment options including vitamin E supplementation showed evidence for improving outcomes such as penile curvature and plaque size. Of the intralesional treatments, Collagenase Clostridium Histolyticum showed evidence for improving penile curvature (Range: 16.3-17 degrees, moderate level certainty of evidence). Intralesional Interferon demonstrated some improvement in curvature (Range: 12-13.5 degrees), plaque size (Range: 1.67-2.2 cm2) and pain, whilst intralesional calcium channel blockers such as Verapamil showed variable evidence for changes in the plaque size and pain. Extracorporeal Shockwave Therapy consistently demonstrated evidence for improving penile pain in stable disease, and two mechanical traction devices improved curvature. Iontophoresis, topical medications, and combination therapies did not demonstrate any consistent improvements in outcome measures. Intralesional options demonstrate the best potential. Overall, results varied with few high-quality randomised trials present.
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Affiliation(s)
- Sulaiman Hayat
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Hussain M Alnajjar
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Onur Omer Cakir
- Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Asif Muneer
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospital, London, United Kingdom
- Male Genital Cancer Centre, University College London, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom.
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
- Khalifa University, Abu Dhabi, United Arab Emirates.
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17
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Dutta M, Kadirvel G, Borah P, Sinha S, Ahmed K, Hazarika G, Sharma R, Choudhury H, Deori S, Das Gupta M, Biswas RK, Tamuly S, Barua PM, Hussain J. Effect of membrane stabilizers on semen quality and sperm membrane protein expression during cryopreservation of goat semen. Cryo Letters 2023; 44:299-306. [PMID: 38032310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Semen cryopreservation is a complex process during which there is alteration in the expression of sperm and seminal plasma proteins, molecular weight of protein or loss of membrane proteins during the process. In order to compensate for these changes, different membrane stabilizers are used in freezing semen extenders. However, there is scarcity of such studies during cryopreservation of goat semen. OBJECTIVE To investigate the effect of membrane stabilizers on sperm membrane protein expression during cryopreservation of goat semen. MATERIALS AND METHODS A total of 36 semen ejaculates from nine Assam Hill Goat bucks aged 2 to 2.5 years was collected by artificial vagina method. Three membrane stabilizers, each at two different concentrations viz. 50 and 80 mM sucrose, 50 and 100 mM trehalose, and 100 and 150 ng per mL IGF-1 (insulin-like growth factor 1 protein) were added to Tris-citric acid fructose egg yolk glycerol (TCFEYG) extender and semen samples were cryopreserved. The sperm membrane protein profile was studied in fresh and cryopreserved semen by SDS-PAGE. RESULTS SDS- PAGE of sperm membrane extract of fresh semen revealed the presence of 24 protein bands with molecular weights ranging from 10 kDa to 240 kDa. Samples supplemented with 50 mM sucrose and 80 mM sucrose revealed 21 protein bands with molecular weights ranging from 10 kDa to 240 kDa. All the 21 protein bands were same as those observed in the sperm membrane of fresh spermatozoa, except that the 23 kDa, 29 kDa and 42 kDa bands were absent in frozen semen. Similarly, frozen semen extended with 50 mM trehalose and 100 mM trehalose revealed 22 protein bands with molecular weights ranging from 10 kDa to 240 kDa, but lacking the 29 kDa and 42 kDa bands. Proteins with molecular weights of 29 kDa, 130 kDa and 240 kDa were absent in frozen semen supplemented with 100 ng per mL IGF-1 and 150 ng per mL IGF-1. CONCLUSION The present study revealed that supplementation of tris basic extender with trehalose at 100 mM and or IGF-1 at 100 ng/mL or 150 ng per mL improves the post-thaw semen characteristics and protects certain fertility related sperm membrane proteins. Doi.org/10.54680/fr23510110612.
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Affiliation(s)
- M Dutta
- College of Veterinary Science, Assam Agricultural University, Khanapara, Assam, India
| | - G Kadirvel
- ICAR Research Complex for NEH Region, Umiam, Meghalaya, India
| | - P Borah
- College of Veterinary Science, Assam Agricultural University, Khanapara, Assam, India
| | - S Sinha
- College of Veterinary Science, Assam Agricultural University, Khanapara, Assam, India
| | - K Ahmed
- College of Veterinary Science, Assam Agricultural University, Khanapara, Assam, India
| | - G Hazarika
- College of Veterinary Science, Assam Agricultural University, Khanapara, Assam, India
| | - R Sharma
- College of Veterinary Science, Assam Agricultural University, Khanapara, Assam, India
| | | | - S Deori
- ICAR Research Complex for NEH Region, Umiam, Meghalaya, India.
| | - M Das Gupta
- College of Veterinary Science, Assam Agricultural University, Khanapara, Assam, India
| | - R K Biswas
- College of Veterinary Science, Assam Agricultural University, Khanapara, Assam, India
| | - S Tamuly
- College of Veterinary Science, Assam Agricultural University, Khanapara, Assam, India
| | - P M Barua
- College of Veterinary Science, Assam Agricultural University, Khanapara, Assam, India
| | - J Hussain
- College of Veterinary Science, Assam Agricultural University, Khanapara, Assam, India
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18
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Jiang S, Macaulay R, Ahmed K, Etame AB, Yu HHM. Characterization of Immune Infiltrates Associated With Radiation Necrosis in the Setting of Brain Metastases Following Stereotactic Radiosurgery and Immunotherapy: A Retrospective Cohort Analysis. Cureus 2023; 15:e43528. [PMID: 37719517 PMCID: PMC10501495 DOI: 10.7759/cureus.43528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Radiation necrosis (RN) is caused by vascular damage and brain parenchymal injury resulting in inflammation following radiotherapy (RT) for brain metastases. The impact of immunotherapy (IO) on the immune cellular microenvironment in patients' brain metastases is unknown. The objective of this study was to characterize the inflammatory microenvironment in the setting of RN compared to recurrent metastasis and determine whether IO treatment affects the cellular infiltrates. METHODS Adult patients with brain metastases from solid tumors who received both systemic IO and RT prior to resection of intracranial lesions were retrospectively analyzed. The resection either showed biopsy-proven RN or recurrent tumor. A group of patients who developed RN and were not on IO was reviewed as well. A total of 18 patients were categorized into one of three groups: necrosis, IO+RT; tumor, IO+RT; and necrosis, RT. Surgical specimens were stained for immune and inflammatory components and reviewed by a neuro-pathologist who remained blinded during the analysis. The presence or absence of lymphocytes, perivascular cuffs, plasma cells, macrophages, and fibrinoid vascular changes was characterized in a semiquantitative manner. RESULTS The median age was 61.5 years (range 37-82 years). Seventy-seven percent of primary cancers were melanoma. Patients with RN were more likely to exhibit immune infiltrates compared to patients with recurrent metastasis. Limited analysis showed 100% of patients in "necrosis, IO+RT" had quantifiable cell counts; conversely, 83.3% of patients in "tumor, IO+RT" lacked quantifiable cell counts. Additionally, 83.3% of patients in "necrosis, RT" showed immune cells, including lymphocytes, macrophages, plasma cells, and cuffing. CONCLUSION The immune microenvironment of brain metastasis following RT and IO showed higher levels of cell infiltrates in the RN setting versus the recurrent tumor setting. Patients who received prior IO compared to those with no IO had similar immune cell infiltrates adjacent to RN. Lower levels of immune cells in tumor recurrence following IO and RT raise the possibility that an environment lacking primed immune cells may decrease the efficacy of IO.
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Affiliation(s)
- Shirley Jiang
- Department of Radiation Oncology, Houston Lee Moffitt Cancer Center, Tampa, USA
- College of Medicine, University of South Florida (USF) Health, Tampa, USA
| | - Robert Macaulay
- Department of Pathology, Houston Lee Moffitt Cancer Center, Tampa, USA
| | - Kamran Ahmed
- Department of Radiation Oncology, Houston Lee Moffitt Cancer Center, Tampa, USA
| | - Arnold B Etame
- Department of Neurosurgery, Houston Lee Moffitt Cancer Center, Tampa, USA
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19
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Singh BM, Kumari-Dewat N, Ryder A, Parry E, Klaire V, Matthews D, Bennion G, Jennens H, Ritzenthaler BME, Rayner S, Shears J, Ahmed K, Sidhu M, Viswanath A, Warren K. Digital health and inpatient palliative care: a cohort-controlled study. BMJ Support Palliat Care 2023:spcare-2023-004474. [PMID: 37491147 DOI: 10.1136/spcare-2023-004474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES End of life has unacceptable levels of hospital admission and death. We aimed to determine the association of a novel digital specific system (Proactive Risk-Based and Data-Driven Assessment of Patients at the End of Life, PRADA) to modify such events. METHODS A cohort-controlled study of those discharged alive, who died within 90 days of discharge, comparing PRADA (n=114) with standard care (n=3730). RESULTS At 90 days, the PRADA group were more likely to die (78.9% vs 46.2%, p<0.001), had a shorter time to death (58±90 vs 178±186 days, p<0.001) but readmission (20.2% vs 37.9%, p<0.001) or death in hospital (4.4% vs 28.9%, p<0.001) was lower with reduced risk for a combined 90-day outcome of postdischarge non-elective admission or hospital death (OR 0.45, 95% CI 0.27-0.74, p<0.001). Tightening criteria with 1:1 matching (n=83 vs 83) showed persistent significant findings in PRADA contact with markedly reduced adverse events (OR 0.15, 95% CI 0.02-0.96, p<0.05). CONCLUSIONS Being seen in hospital by a specialist palliative care team using the PRADA tool was associated with significantly improved postdischarge outcomes pertaining to those destined to die after discharge.
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Affiliation(s)
- Baldev Malkit Singh
- Institute of Digital Health, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Research Institute for Health Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Nisha Kumari-Dewat
- Community Nursing, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Adam Ryder
- Departmenet of Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Emma Parry
- Academic Unit of Primary Care, Institute of Digital Health, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- School of Medicine, Keele University, Keele, UK
| | - Vijay Klaire
- Digital Innovation Unit, Institute of Digital Health, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Dawn Matthews
- Department of Palliative Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Gemma Bennion
- Department of Palliative Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Hannah Jennens
- Department of Palliative Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Benoit M E Ritzenthaler
- Department of Palliative Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Sophie Rayner
- Department of Palliative Medicine, Derriford Hospital, Plymouth, UK
| | - Jean Shears
- Departmenet of Medicine, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - Mona Sidhu
- Lea Road Medical Practice, Wolverhampton, UK
| | - Ananth Viswanath
- Department of Diabetes and Endocrinology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Kate Warren
- Digital Innovation Unit, Institute of Digital Health, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Department of Public Health, Wolverhampton City Council, Wolverhampton, UK
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20
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Abd Majid N, Rahmat MM, Ahmed K. Independent directors’ attributes and related party transactions in Malaysia: evidence from an individual perspective. JFRA 2023. [DOI: 10.1108/jfra-08-2022-0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Purpose
This study aims to examine the ability of independent directors to discipline related-party transactions (RPTs) among listed companies in Malaysia. Firms typically appoint independent directors individually, not as a group. However, board members are commonly viewed collectively as a group, and evidence of the abilities of individual directors is scarce.
Design/methodology/approach
The attributes of individual independent directors include accounting literacy, length of service, audit committee membership and active participation in board and audit committee meetings. The unit of analysis is the individual independent director. The final sample consists of 1,552 observations in 2017, and RPTs are categorized as either efficient or conflicting.
Findings
The study finds that the tenure of individual independent directors and active participation in board meetings affect the firm’s engagement in RPTs. However, the financial literacy, audit committee membership and attendance of independent directors at audit committee meetings do not affect the firm’s engagement in RPTs, either efficient or conflicting. Overall, this result offers limited support for the upper-echelon theory concerning the attributes of individual independent directors and RPTs.
Research limitations/implications
This study uses cross-sectional observations for 2017, which predates the COVID-19 pandemic. Thus, this study ignores the impact of restrictions in community mobility during the pandemic on the independent director’s ability to monitor the corporation. This circumstance may have implications for practice and merit further research.
Practical implications
The findings provide information for board nominating committees, regulators and policymakers that the capability of individual independent directors to fulfill their responsibilities is limited. The firm’s nominating committee must be very selective in nominating and appointing independent directors with appropriate competencies. Investors should choose companies that have reappointed the same independent directors for an extended period, as they may benefit from the experience in protecting investors’ interests.
Originality/value
This paper contributes novel evidence to upper-echelon theory literature on the association between independent directors and RPT types from the perspective of individual independent directors.
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21
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Dunckley M, Ahmed K, Said A, Raza M, Dighe S, Al-Temimi A. Variability in the presentation of complicated jejunal diverticulosis. JRSM Open 2023; 14:20542704231183247. [PMID: 37425033 PMCID: PMC10328167 DOI: 10.1177/20542704231183247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Jejunal diverticulosis is a rare disease which normally presents for the first time with acute complications, often requiring surgical intervention. The diverticulae are acquired, occurring more commonly after middle age, but their aetiology is unclear. We discuss this condition in the context of four cases which presented to our hospital as emergencies over a five year period: small bowel obstruction, gastrointestinal haemorrhage, small bowel volvulus, and visceral perforation. Our aim is to encourage clinicians to include jejunal diverticular disease as a differential diagnosis in patients with abdominal symptoms.
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Affiliation(s)
- M.G. Dunckley
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
| | - K. Ahmed
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
| | - A. Said
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
| | - M. Raza
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
| | - S. Dighe
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
| | - A. Al-Temimi
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
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22
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Abstract
This review aims to provide an update on the role of augmented reality (AR) in surgical training and investigate whether the use of AR improves performance measures compared to traditional approaches in surgical trainees. PUBMED, EMBASE, Google Scholar, Cochrane Library, British Library and Science Direct were searched following PRIMSA guidelines. All English language original studies pertaining to AR in surgical training were eligible for inclusion. Qualitative analysis was performed and results were categorised according to simulator models, subsequently being evaluated using Messick's framework for validity and McGaghie's translational outcomes for simulation-based learning. Of the 1132 results retrieved, 45 were included in the study. 29 platforms were identified, with the highest 'level of effectiveness' recorded as 3. In terms of validity parameters, 10 AR models received a strong 'content validity' score of 2.15 models had a 'response processes' score ≥ 1. 'Internal structure' and 'consequences' were largely not discussed. 'Relations to other variables' was the best assessed criterion, with 9 platforms achieving a high score of 2. Overall, the Microsoft HoloLens received the highest level of recommendation for both validity and level of effectiveness. Augmented reality in surgical education is feasible and effective as an adjunct to traditional training. The Microsoft HoloLens has shown the most promising results across all parameters and produced improved performance measures in surgical trainees. In terms of the other simulator models, further research is required with stronger study designs, in order to validate the use of AR in surgical training.
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Affiliation(s)
- Dhivya Suresh
- Guy’s, King’s and St Thomas’ School of Medical Education, King’s College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy’s Hospital, King’s College London, London, UK
| | - Stuart James
- Department of General Surgery, Princess Royal University Hospital, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy’s Hospital, King’s College London, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy’s Hospital, King’s College London, London, UK
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23
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Mak Q, Greig J, Ahmed K, Khan S, Dasgupta P, Malde S, Raison N. Competitive Inoculation as an Effective Prophylaxis Against Recurrent Urinary Tract Infections: A Systematic Review. Int Neurourol J 2023; 27:79-87. [PMID: 37401018 DOI: 10.5213/inj.2346052.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/09/2023] [Indexed: 07/05/2023] Open
Abstract
Urinary tract infection (UTI) is a common condition defined as the presence of bacteria within the urine above a certain threshold (usually >100,000 m/L). The lifetime risk in women is estimated to be 50%, of whom 25% will develop recurrence within 6 months. Unfortunately, the use of antibiotics to treat and manage recurrent UTI (rUTI) is a growing problem, due to the burden of growing antibiotic resistance on public health. As such, new approaches to manage rUTI are being investigated and developed. Competitive inoculation via instillation of Escherichia coli 83972 or HU2117 in the bladder is a new prophylactic non-antimicrobial therapy for rUTIs. It utilizes the principle of the protective nature of asymptomatic bacteriuria to prevent recurrence of symptomatic UTIs. However, the effectiveness and safety of this technique remains unclear. This systematic review examined the current outcomes data on competitive inoculation as an effective and safe treatment for rUTI prophylaxis. Based on a limited number of studies, current evidence suggests that competitive inoculation is an effective and safe prophylactic measure against UTIs in a select group of patients with incomplete bladder emptying. However, administration of the technology is both resource and time intensive, and there is strong data demonstrating low successful colonisation rates. Competitive inoculation is an alternative to antibiotics only to rUTI patients with incomplete bladder emptying. There is no evidence to suggest that the technology would be suitable for other subsets of rUTI patients. Further randomized controlled trials should be conducted to improve the evidence base before drawing conclusions for clinical practice, and ideas to improve colonisation rates and simplify the administration process should be explored.
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Affiliation(s)
- Quentin Mak
- GKT School of Medical Education, King's College London, London, UK
| | - Julian Greig
- GKT School of Medical Education, King's College London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
- Khalifa University, Abu Dhabi, United Arab Emirates
| | - Shamim Khan
- Department of Urology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
- Department of Urology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Sachin Malde
- Department of Urology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Raison
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
- Department of Urology, Guys and St Thomas' NHS Foundation Trust, London, UK
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24
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Chahal B, Aydin A, Ali Amin MS, Khan A, Khan MS, Ahmed K, Dasgupta P. The learning curves of major laparoscopic and robotic procedures in urology: A systematic review. Int J Surg 2023:01279778-990000000-00318. [PMID: 37132184 PMCID: PMC10389344 DOI: 10.1097/js9.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 03/06/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Urology has been at the forefront of adopting laparoscopic and robot-assisted techniques to improve patient outcomes. This systematic review aimed to examine the literature relating to the learning curves of major urological robotic and laparoscopic procedures. METHODS In accordance with PRISMA guidelines, a systematic literature search strategy was employed across PubMed, EMBASE, and the Cochrane Library from inception to December 2021 alongside a search of the grey literature. Two independent reviewers completed the article screening and data extraction stages, using the Newcastle-Ottawa Scale as a quality assessment tool. The review was reported in accordance with AMSTAR guidelines. RESULTS Of 3702 records identified, 97 eligible studies were included for narrative synthesis. Learning curves are mapped using an array of measurements including operative time, estimated blood loss, complication rates as well as procedure-specific outcomes, with operative time being the most commonly used metric by eligible studies. The learning curve for operative time was identified as 10-250 cases for robot-assisted laparoscopic prostatectomy (RALP), and 40-250 for laparoscopic radical prostatectomy (LRP).The robot-assisted partial nephrectomy (RAPN) learning curve for warm ischaemia time is 4-150 cases. No high-quality studies evaluating the learning curve for laparoscopic radical cystectomy and for robotic and laparoscopic retroperitoneal lymph node dissection were identified. CONCLUSION There was considerable variation in the definitions of outcome measures and performance thresholds, with poor reporting of potential confounders. Future studies should use multiple surgeons and large sample sizes of cases to identify the currently undefined learning curves for robotic and laparoscopic urological procedures.
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Affiliation(s)
- Baldev Chahal
- MRC Centre for Transplantation, Guy's Hospital, King's College London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, UK
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Azhar Khan
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
- Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, UK
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, UK
- Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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25
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Abstract
BACKGROUND Educational videos are a potent resource for the learning of surgical skills among different study cohorts. However, there is limited evidence on the effectiveness of different educational video interventions and their features. UNLABELLED A systematic search of MEDLINE (via PubMed), Embase (via OVID), Cochrane libraries and Clinicaltrials.gov was performed from inception to 28/02/21. Studies included were not limited by date of publication, studies aiming to assess the impact of video-based interventions in the direct acquisition of surgical skill were included. Eligible studies were analysed based on study type, type of video intervention, method of assessment and period of education. The educational impact of the studies was also assessed as per Messick's framework for testing validity of evaluation methods and McGhagie's model for analysing translational outcomes. UNLABELLED 22 studies were deemed suitable for inclusion, of which 14/22 (63.6%) demonstrated a significant improvement in knowledge/skills following the video-based teaching interventions, 3/22 (13.6%) studies demonstrated an improvement in trainee satisfaction scores. A recurrent limitation of the included studies was the lack of validation of selected assessment methods. None of the included studies scored on all 5 parameters of validity as defined by Messicks validity framework. Furthermore, none of the included trials were conducted for long enough to indicate direct changes to patient outcomes resultant from educational methods. CONCLUSION Video-based surgical education is effective in learning surgical skills within different levels of surgical training; however, superior study quality and follow-up is required to determine which aspects of video-based interventions are most impactful.
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Affiliation(s)
- Samy Cheikh Youssef
- Guy’s, King’s and St Thomas’ School
of Medical Education, King’s College London, London, UK
| | - Abdullatif Aydin
- Guy’s Hospital, King’s College
London, MRC Centre for
Transplantation, London, UK
| | - Alexander Canning
- Guy’s, King’s and St Thomas’ School
of Medical Education, King’s College London, London, UK
| | - Nawal Khan
- Department of Urology, The London Clinic, London, UK
| | - Kamran Ahmed
- Guy’s Hospital, King’s College
London, MRC Centre for
Transplantation, London, UK
| | - Prokar Dasgupta
- Guy’s Hospital, King’s College
London, MRC Centre for
Transplantation, London, UK
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26
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Brunckhorst O, Liszka J, James C, Fanshawe JB, Hammadeh M, Thomas R, Khan S, Sheriff M, Ahmed HU, Van Hemelrijck M, Muir G, Stewart R, Dasgupta P, Ahmed K. Mental wellbeing and quality of life in prostate cancer (MIND-P): Protocol for a multi-institutional prospective cohort study. PLoS One 2023; 18:e0284727. [PMID: 37093833 PMCID: PMC10124830 DOI: 10.1371/journal.pone.0284727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND The mental wellbeing implications of a prostate cancer diagnosis are increasingly being realised. Significant mental health symptoms such as depression and anxiety, along with related constructs such as fear of cancer recurrence, body image and masculine self-esteem issues are prevalent. However, less is understood about potential prognostic factors for these outcomes in prostate cancer patients. Therefore, this study aims to primarily explore potential treatment, patient and oncological factors associated with mental wellbeing outcomes in the initial prostate cancer follow-up period. METHODS MIND-P is a multi-institutional prospective cohort study recruiting newly diagnosed prostate cancer patients for 12-month follow up. It will aim to recruit a final sample of 300 participants undergoing one of four treatment options: active surveillance, radical prostatectomy, radical radiotherapy, or hormone monotherapy. Questionnaire-based data collection consists of multiple validated mental, physical, and social wellbeing outcomes at baseline and 3-monthly intervals until study completion. Primary analysis will include evaluation of treatment undergone against multiple mental wellbeing outcomes. Secondary analysis will additionally explore multiple patient and oncological prognostic factors of potential importance, along with the cumulative incidence of these outcomes, symptom trajectory and their association with subsequent functional and social outcomes. CONCLUSION This cohort study aims to add to the existing limited literature evaluating significant prognostic factors for multiple mental wellbeing outcomes in newly diagnosed prostate cancer patients. This may be of potential use for guiding future prognosis research and of clinical use for identifying individuals potentially requiring additional surveillance or support during routine cancer follow up. STUDY REGISTRATION This study was prospectively registered on ClinicalTrials.gov (NCT04647474).
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Affiliation(s)
- Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Jaroslaw Liszka
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Callum James
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Jack B Fanshawe
- Department of Urology, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Mohamed Hammadeh
- Department of Urology, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Robert Thomas
- The Primrose Oncology Unit, Bedfordshire Hospitals NHS Foundation Trust, Bedford, United Kingdom
| | - Shahid Khan
- Department of Urology, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom
| | - Matin Sheriff
- Department of Urology, Medway NHS Foundation Trust, Gillingham, United Kingdom
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Charring Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Gordon Muir
- Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Robert Stewart
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
- Department of Urology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Khalifa University, Abu Dhabi, United Arab Emirates
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27
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Vyas N, Brunckhorst O, Fox L, Van Hemelrijck M, Muir G, Stewart R, Dasgupta P, Ahmed K. Undergoing radical treatment for prostate cancer and its impact on wellbeing: A qualitative study exploring men's experiences. PLoS One 2022; 17:e0279250. [PMID: 36525457 PMCID: PMC9757548 DOI: 10.1371/journal.pone.0279250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Quality of life in prostate cancer survivorship is becoming increasingly important, with mental and social wellbeing recognised as key components. However, limited global evaluation of psychosocial challenges experienced after treatment exists. Therefore, we aimed to explore the lived experiences of men who underwent radical treatment, and its psychosocial impact. MATERIAL AND METHODS This qualitative study was conducted using 19 men who had undergone radical treatment (prostatectomy or radiotherapy) for their cancer. Semi-structured interviews were conducted exploring lived experiences of men after treatment. A Structured thematic analysis of collected data was undertaken, with an inductive co-construction of themes through the lens of the biopsychosocial model. Themes generated were considered within a psychological, social, and physical wellbeing framework. RESULTS An initial knowledge gap meant mental wellbeing was strongly impacted initially leading to a 'Diagnostic Blow and the Search for Clarity'. Doubt over individuals' future resulted in 'An Uncertain Future' in many men. Once treatment was completed a 'Reflective journey' began, with men considering their outcomes and decisions made. Social wellbeing was also impacted with many identifying the 'Emotional Repercussions' on their relationships and the impact their diagnosis had on their partner and family. Many subsequently sought to increase their support through 'The Social Network and Advocacy', while physical changes led to an increased need for 'Social Planning'. Finally, physical wellbeing was highlighted by a continual acknowledgement of the 'Natural process of ageing' leading to a reluctancy to seek help, whilst simultaneously attempting to improve existing health via 'The Health Kick'. CONCLUSIONS Radical treatments have a considerable impact on mental and social wellbeing of individuals. Anxiety after diagnosis and significant uncertainty over individual futures exist, with physical complications of treatment leading to social repercussions. Future research should aim to identify forms of support to improve quality of life of these men.
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Affiliation(s)
- Neel Vyas
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
| | - Louis Fox
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Gordon Muir
- Department of Urology, King’s College Hospital, London, United Kingdom
| | - Robert Stewart
- King’s College London Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
- Urology Centre, Guy’s and St. Thomas’ NHS Foundation Trust, King’s Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Khalifa University, Abu Dhabi, United Arab Emirates
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28
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Hussain M, Ahmed K, Begum SS, Kalita MK, Borah P, Bhuyan D, Tamuly S, Medhi D, Paul V, Chakravartya P, Sarkar M. 70 Effect of seasons and additives in Arunachali yak bull semen at different stages of processing and freezing along with fresh semen characteristics. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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29
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Pina Y, Chen A, Arrington JA, Macaulay R, Tran N, Liu J, Mokhtari S, Li J, Law V, Sahebjam S, Ahmed K, Creelan B, Gray J, Wallace G, Evernden B, Stewart CL, Khushalani N, Smalley I, Smalley K, Vogelbaum M, Yu M, Forsyth P. CTIM-01. TITLE: PHASE 1B STUDY OF AVELUMAB AND WHOLE BRAIN RADIOTHERAPY (WBRT) IN PATIENTS WITH LEPTOMENINGEAL DISEASE (LMD): PRELIMINARY RESULTS. Neuro Oncol 2022. [PMCID: PMC9660961 DOI: 10.1093/neuonc/noac209.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
LMD from systemic cancer has a dismal prognosis with median survivals of 8-10 weeks. A phase 2 trial of PD-1 inhibitor monotherapy in LMD showed median overall survival (OS) of 3.6 months (Brastianos P et al., 2020). We determined the safety/efficacy of avelumab, a PD-L1 inhibitor with WBRT in patients with LMD (NCT0371768). This combination can treat the tumor directly and increase BBB permeability (Li, 2003; Nordal, 2005) allowing the increased egress of activated T cells into the meninges/CSF.
METHODS
Patients received concurrent avelumab 800 mg IV q2 weeks for ≤ 5 cycles (unless PD or unacceptable toxicity) with WBRT 3000 cGy in 10 fractions. Primary endpoints are safety/DLTs and OS at 3 months. Secondary endpoints are CSF T-cell/cytokine profiles (scRNAseq, phosophoproteomics etc.).
RESULTS
A total of 15 patients (7 breast, 7 lung & 1 other) were enrolled (n = 13 F, ages 32-79). Pts receiving anti-PD-1/PD-1L/PD-L2/CD137,CTLA-4 therapy ≤ 6 months prior were excluded. Three of 15 patients had grade 3/4 AEs (diarrhea, lymphopenia, decreased WBC count in 3 patients). Seven patients (50%) were alive at 3 or 6 months. The estimated median follow up in 14 patients is 4.75 months (range, 0.92 – 30.05 months, 95% CI is 1.32 ~ 19.82). The median PFS is 3.75 months (95% CI = 0.85-15.16) and median OS is 6.89 months (95% CI = 1.18-14.7).
CONCLUSIONS
The combination of avelumab and WBRT is safe, well tolerated, and demonstrates encouraging activity in patients with LMD with an OS that is longer than other published series. Multiple platform interrogation of CSF (analysis underway) will determine mechanisms of LMD therapeutic/resistance effects.
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Affiliation(s)
| | - Ann Chen
- Moffitt Cancer Center , Tampa, FL , USA
| | | | | | - Nam Tran
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
| | - James Liu
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | | | | | - Vincent Law
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | - Solmaz Sahebjam
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Kamran Ahmed
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
| | | | | | | | | | | | | | | | | | - Michael Vogelbaum
- Department of NeuroOncology, Moffitt Cancer Center , Tampa, FL , USA
| | - Michael Yu
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
| | - Peter Forsyth
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
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30
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Pandey S, Kutuk T, Mills M, Abdalah M, Stringfield O, Latifi K, Moreno W, Ahmed K, Raghunand N. NIMG-01. PREDICTING POST-STEREOTACTIC RADIOTHERAPY MAGNETIC RESONANCE IMAGE OUTCOMES OF BREAST CANCER METASTASES TO THE BRAIN. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Stereotactic radiosurgery (SRS) is a cornerstone in the management of Breast Cancer Metastases to the Brain (BCMB). While control rates are high following SRS, radiation necrosis is a rare but potentially devastating long-term toxicity. There is a clinical need for automated/semi-automated methods to assess tumor response and optimize the RT plans for local control with minimal long-term toxicity. Multiparametric MRI (mpMRI), particularly Apparent Diffusion Coefficient of water (ADC) maps, contain information that is mechanistically relatable to voxel-level tumor response to RT. We report a deep learning-based approach to predict post-SRS ADC maps, FLAIR, T2-weighted (T2W), T1-weighted unenhanced (T1W) and contrast-enhanced (T1WCE) images, from pre-SRS T1W, T1WCE, T2W and FLAIR images, ADC maps, and the delivered RT dose map. These “forward models” will enable the radiation oncologist to simulate radiologic outcomes and iteratively optimize RT plans for local control with minimal toxicity.
METHODS
We trained a variant of the pix2pix Generative Adversarial Network (GAN) on MRI and RT dose map data from 18 BCMB patients treated with stereotactic radiation with confirmed controlled and locally recurrent metastases. Patients were treated with stereotactic radiation dose of 1-40 Gy between 2013-2019.
RESULTS
On test data from 6 BCMB patients, the trained forward model predicted post-SRS ADC values within the Gross Tumor Volume (GTV) that were broadly in agreement with ground truth post-SRS ADC maps. In agreement with expectations, the forward model also predicts increasing post-RT ADC within the GTV with increasing simulated RT doses in the range of 1-71 Gy. We have also explored an inverse model to predict the RT dose map required to produce “prescribed” post-SRS ADC values within the GTV.
CONCLUSIONS
We envision that the forward models will assist the radiation oncologist in initial RT dose plan optimization, while the inverse model may be useful for daily RT plan optimization.
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Affiliation(s)
| | - Tugce Kutuk
- Miami Cancer Institute, Baptist Health South Florida , Miami, FL , USA
| | - Matthew Mills
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | - Mahmoud Abdalah
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | - Olya Stringfield
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | - Kujtim Latifi
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | | | - Kamran Ahmed
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
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Tang J, Dohm A, Kalagotla H, Bhandari M, Kim Y, Graham J, Khushalani N, Forsyth P, Etame A, Liu J, Tran N, Vogelbaum M, Yu M, Ahmed K, Oliver D. RADT-11. CLINICAL OUTCOMES IN THE MANAGEMENT OF MELANOMA BRAIN METASTASES TREATED WITH STEREOTACTIC RADIOSURGERY AND ANTI-PD-1+CTLA-4. Neuro Oncol 2022. [PMCID: PMC9660905 DOI: 10.1093/neuonc/noac209.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Anti-PD-1+CTLA-4 therapy has revolutionized melanoma brain metastases (MBM) treatment. Prospective trials show higher response in asymptomatic versus symptomatic patients. We evaluated clinical outcomes in MBM treated with stereotactic radiosurgery (SRS) and anti-PD-1+CTLA-4.
METHODS
Patients were included if MBM were diagnosed and treated with SRS within 3 months of anti-PD-1+CTLA-4, and this was their last course of systemic treatment. Endpoints of this study were distant MBM control, MBM local control (LC) defined as less than 20% volume increase on follow-up MRI, and overall survival (OS) from SRS. Adverse advents were evaluated using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
RESULTS
29 patients with 122 MBM treated over 40 SRS sessions between 2015-2020 were identified. Median SRS dose: 24 Gy (range: 15-24). Median MBM diameter: 0.6 cm (range: 0.3-2.9). Median follow-up using reverse Kaplan-Meier (KM) method: 19.3 months (interquartile range: 14.6-38.4).Six-, twelve-, and eighteen-month KM distant MBM control rates were 51%, 42%, 42%, respectively. LC rates: 90%, 86%, 85%. OS rates: 76%, 68%, 56%. 17 patients (59%) were asymptomatic and 12 (41%) symptomatic. KM distant MBM control and OS for asymptomatic and symptomatic patients were not significant; p=0.61 and p=0.67, respectively.On univariate analysis (UVA), Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) 0-1 was associated with increased risk of distant MBM failure versus DS-GPA 3.5-4 (hazard ratio (HR): 9.8, 95% confidence interval (CI) 1.9-51.5, p=0.007). UVA showed decreased OS with increased number of organs with metastases at diagnosis (HR:12, 95% CI 2.0-83.1, p=0.0075).2 lesions (1.6%) developed symptomatic radiation necrosis requiring steroids; 10 lesions developed grade 3 edema (8%); 13 patients experienced grade 1-2 fatigue and/or headache (45%); no patients experienced grade >3 events.
CONCLUSION
Combination SRS and anti-PD-1+CTLA-4 in MBM shows durable intracranial control with similar outcomes between asymptomatic and symptomatic patients with acceptable toxicity. Further study is warranted.
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Affiliation(s)
- Joseph Tang
- USF Morsani College of Medicine , Palo Alto, CA , USA
| | - Ammoren Dohm
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
| | | | - Menal Bhandari
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
| | - Youngchul Kim
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
| | - Jasmine Graham
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
| | | | - Peter Forsyth
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | - Arnold Etame
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
| | - James Liu
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | - Nam Tran
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
| | | | - Michael Yu
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
| | - Kamran Ahmed
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
| | - Daniel Oliver
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
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Shepherd A, Brunckhorst O, Ahmed K, Xu Q. Botanicals in health and disease of the testis and male fertility: A scoping review. Phytomedicine 2022; 106:154398. [PMID: 36049429 DOI: 10.1016/j.phymed.2022.154398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 07/18/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Male factor infertility often results from testicular disorders leading to inadequate sperm quantity and quality. Both beneficial and detrimental effects of botanical products, especially herbal medicines, on testicular functions and male fertility have been reported in the literature. PURPOSE This scoping review aims to map the main clinical evidence on different impacts of botanical entities on the testis and to critically appraise relevant randomized controlled trials (RCTs) published in the recent 5 years, so as to inform the future. METHODS Systematic reviews, meta-analyses and RCT reports on botanical impacts on testicular functions and male fertility were retrieved and synthesized from Pubmed, Web of Science, Scopus, Embase, ProQuest, Cochrane Library and Google Scholar up to 10th May 2022. RCTs published since 2018 were critically appraised against good practice guidelines for RCT and for reporting herbal studies. RESULTS We identified 24 systematic reviews and meta-analyses published since 2005, by authors from Iran (25%), China (21%), USA (12.5%) and 9 other countries. All but two were published in English. Only 3 systematic review protocols were identified, all published in English from China in the recent 3 years. We identified 125 RCTs published in six languages, mainly English (55%) and Chinese (42%). They were published since 1994 from 23 countries on all the six inhabitable continents, with China (46%), Australia (8%), USA (8%), India (7%) and Iran (5%) being the leading contributors. 72% and 28% RCTs published in English were on efficacy (botanicals vs placebo) and comparative effectiveness (a botanical vs other treatments), respectively. In contrast, 98% RCT reports in Chinese were on comparative effectiveness, with merely 2% on efficacy. Among all the 125 RCTs, 57% were studies in patients with semen abnormality and/or male infertility, 22% investigated herbal effects in healthy men, 14% were on patients with male sexual dysfunction and hypogonadism, and 7% were conducted in men with non-sexual disorders. Since 2018, 32 RCTs have been published, in English (69%) or Chinese (31%). Nineteen RCT reports from China, India, Japan and Korea all studied herbal formulae while the 13 RCT reports from Australia, Brazil, Czech and Italy, Iran, Malaysia, Spain, the UK and the USA all exclusively studied extracts of a single species. Putting geo-cultural differences aside, gossypol and extracts of Tripterygium wilfordii Hook. f. were found to be detrimental to the testis and male fertility, while the extracts of Withania somnifera (L.) Dunal and traditional Chinese medicine Qilin Pill, etc., might improve testosterone levels and semen parameters, thus could be therapeutic for male sexual dysfunction and infertility. However, all still require further evaluation in view of recurring weaknesses in quality control of herbal materials, RCT design and reporting. For example, only 9%-23% of the RCTs published since 2018 provided information on voucher samples, chemical profiling, herbal authentication and herbal extraction. CONCLUSION Research on botanicals and the testis has been reported worldwide, demonstrating clear geo-cultural differences in studied plant species, botanical types, study objectives and quality of research design, implementation and reporting. Due to a few recurring weaknesses in the literature, this study is unable to recommend the use of any specific botanicals, however, current evidence does indicate that botanicals can be double-edged swords to the testis and male fertility. To secure better clinical evidence, future studies must faithfully implement existing and emerging good practice guidelines.
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Affiliation(s)
- Adam Shepherd
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom; Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Department of Epidemiology and Public Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Qihe Xu
- Renal Sciences and Integrative Chinese Medicine Laboratory, Department of Inflammation Biology, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
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Amjad M, Ahmed I, Ahmed K, Alqarni MS, Akbar T, Muhammad T. Numerical Solution of Magnetized Williamson Nanofluid Flow over an Exponentially Stretching Permeable Surface with Temperature Dependent Viscosity and Thermal Conductivity. Nanomaterials (Basel) 2022; 12:3661. [PMID: 36296851 PMCID: PMC9609392 DOI: 10.3390/nano12203661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
This research work describes and investigates Williamson nanofluid flow over an exponentially stretching permeable vertical plate with temperature-dependent thermal conductivity and viscosity. The governing non-linear partial differential equations (PDEs) are metamorphosed into coupled non-linear ordinary differential equations (ODEs) by using similarity transformation. The succeeding equations were numerically solved using MATLAB function bvp4c for various values of parameters. For velocity, temperature, concentration, the skin friction coefficient, and the local Nusselt number, data are presented in the form of graphs and tables. It is noted that for increasing values of magnetic parameter M, Williamson parameter λ, and viscosity parameter α, the boundary layer thickness of the velocity profile decreases, while it increases for the temperature profile. The findings of the present work are validated through the published results.
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Affiliation(s)
- Muhammad Amjad
- Department of Mathematics, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Iftikhar Ahmed
- Department of Mathematics, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Kamran Ahmed
- Department of Mathematics, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Marei Saeed Alqarni
- Department of Mathematics, College of Science, King Khalid University, Abha 61413, Saudi Arabia
| | - Tanvir Akbar
- Department of Mathematics, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Taseer Muhammad
- Department of Mathematics, College of Science, King Khalid University, Abha 61413, Saudi Arabia
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Saleem MT, Shoaib MH, Yousuf RI, Ahmed FR, Ahmed K, Siddiqui F, Mahmood ZA, Sikandar M, Imtiaz MS. SeDeM tool-driven full factorial design for osmotic drug delivery of tramadol HCl: Formulation development, physicochemical evaluation, and in-silico PBPK modeling for predictive pharmacokinetic evaluation using GastroPlus™. Front Pharmacol 2022; 13:974715. [PMID: 36278217 PMCID: PMC9585207 DOI: 10.3389/fphar.2022.974715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
The study is based on using SeDeM expert system in developing controlled-release tramadol HCl osmotic tablets and its in-silico physiologically based pharmacokinetic (PBPK) modeling for in-vivo pharmacokinetic evaluation. A Quality by Design (QbD) based approach in developing SeDEM-driven full factorial osmotic drug delivery was applied. A 24 Full-factorial design was used to make the trial formulations of tramadol HCl osmotic tablets using NaCl as osmogen, Methocel K4M as rate controlling polymer, and avicel pH 101 as diluent. The preformulation characteristics of formulations (F1-F16) were determined by applying SeDeM Expert Tool. The formulation was optimized followed by in-vivo predictive pharmacokinetic assessment using PBPK “ACAT” model of GastroPlus™. The FTIR results showed no interaction among the ingredients. The index of good compressibility (ICG) values of all trial formulation blends were ≥5, suggesting direct compression is the best-suited method. Formulation F3 and F4 were optimized based on drug release at 2, 10, and 16 h with a zero-order kinetic release (r2 = 0.992 and 0.994). The SEM images confirmed micropores formation on the surface of the osmotic tablet after complete drug release. F3 and F4 were also stable (shelf life 29.41 and 23.46 months). The in vivo simulation of the pharmacokinetics of the PBPK in-silico model revealed excellent relative bioavailability of F3 and F4 with reference to tramadol HCl 50 mg IR formulations. The SeDeM expert tool was best utilized to evaluate the compression characteristics of selected formulation excipients and their blends for direct compression method in designing once-daily osmotically controlled-release tramadol HCl tablets. The in-silico GastroPlus™ PBPK modeling provided a thorough pharmacokinetic assessment of the optimized formulation as an alternative to tramadol HCl in vivo studies.
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Aydın A, Ahmed K, Abe T, Raison N, Van Hemelrijck M, Garmo H, Ahmed HU, Mukhtar F, Al-Jabir A, Brunckhorst O, Shinohara N, Zhu W, Zeng G, Sfakianos JP, Gupta M, Tewari A, Serdar Gözen A, Rassweiler J, Skolarikos A, Kunit T, Knoll T, Moltzahn F, Thalmann GN, Lantz Powers AG, Chew BH, Sarica K, Shamim Khan M, Dasgupta P. Erratum to "Effect of Simulation-based Training on Surgical Proficiency and Patient Outcomes: A Randomised Controlled Clinical and Educational Trial" [Eur Urol 2022;81:385-393]. Eur Urol 2022; 82:e179. [PMID: 36114080 DOI: 10.1016/j.eururo.2022.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Abdullatif Aydın
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK.
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK; Department of Urology, King's College Hospital NHS Foundation Trust, King's Health Partners, London, UK
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nicholas Raison
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK
| | | | - Hans Garmo
- School of Cancer and Pharmaceutical Studies, King's College London, London, UK
| | - Hashim U Ahmed
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Furhan Mukhtar
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK
| | - Ahmed Al-Jabir
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wei Zhu
- Department of Urology, Minimally Invasive Surgery Centre, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Centre, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ali Serdar Gözen
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Jens Rassweiler
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Kunit
- Department of Urology and Andrology, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Böblingen, University of Tübingen, Sindelfingen, Germany
| | - Felix Moltzahn
- Department of Urology, University of Bern, Bern, Switzerland
| | | | | | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kemal Sarica
- Department of Urology, Biruni University Hospital, Istanbul, Turkey
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK; Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK; Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
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Sikandar M, Shoaib MH, Yousuf RI, Ahmed FR, Ali FR, Saleem MT, Ahmed K, Sarfaraz S, Jabeen S, Siddiqui F, Husain T, Qazi F, Imtiaz MS. Nanoclay-Based Composite Films for Transdermal Drug Delivery: Development, Characterization, and in silico Modeling and Simulation. Int J Nanomedicine 2022; 17:3463-3481. [PMID: 35959283 PMCID: PMC9359522 DOI: 10.2147/ijn.s367540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/24/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Halloysite nanotubes (HNTs) are a versatile and highly investigated clay mineral due to their natural availability, low cost, strong mechanical strength, biocompatibility, and binding properties. The present work explores its role for retarding and controlling the drug release from the composite polymer matrix material. Methods For this purpose, nanocomposite films comprising propranolol HCl and different concentrations of HNTs were formulated using the “solution casting method”. The menthol in a concentration of 1% w/v was used as a permeation enhancer, and its effect on release and permeation was also determined. Quality characteristics of the nanocomposite were determined, and in vitro release and permeation studies were performed using the Franz diffusion system. The data was analyzed using various mathematical models and permeation parameters. Optimized formulation was also subjected to skin irritation test, FTIR, DSC, and SEM study. Systemic absorption and disposition of propranolol HCl from the nanocomposites were predicted using the GastroPlus TCAT® model. Results The control in drug release rate was associated with the higher concentration of HNTs. F8 released 50% of propranolol within 8 hours (drug, HNTs ratio, 1:2). The optimized formulation (F6) with drug: HNTs (2:1), exhibited drug release 80% in 4 hours, with maximum flux of 145.812 µg/cm2hr. The optimized formulation was found to be a non-irritant for skin with a shelf life of 35.46 months (28–30 ℃). The in silico model predicted Cmax, Tmax, AUCt, and AUCinf as 32.113 ng/mL, 16.58 h, 942.34 ng/mL×h, and 1102.9 ng/mL×h, respectively. Conclusion The study demonstrated that HNTs could be effectively used as rate controlling agent in matrix type transdermal formulations.
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Affiliation(s)
- Muhammad Sikandar
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Muhammad Harris Shoaib
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
- Correspondence: Muhammad Harris Shoaib, Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan, Email ;
| | - Rabia Ismail Yousuf
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Farrukh Rafiq Ahmed
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Fatima Ramzan Ali
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
- Jinnah College of Pharmacy, Sohail University, Karachi, 74000, Pakistan
| | - Muhammad Talha Saleem
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Kamran Ahmed
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Sana Sarfaraz
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Sabahat Jabeen
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Fahad Siddiqui
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Tazeen Husain
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Faaiza Qazi
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Muhammad Suleman Imtiaz
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
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Hafez W, Ahmed S, Abbas N, Ahmed K, Kamran S, Arya A, Rao SR, Abdelshakor M, Ali S, Sebastian H, Tariq M, Lal K, Abdelrahman A. ABO Blood Group in Relation to COVID-19 Susceptibility and Clinical Outcomes: A Retrospective Observational Study in the United Arab Emirates. Life (Basel) 2022; 12:life12081157. [PMID: 36013335 PMCID: PMC9410437 DOI: 10.3390/life12081157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/21/2022]
Abstract
(1) Background: The association between ABO blood groups and COVID-19 outcomes was investigated in several studies. The results were controversial. This study aimed to explore the association between ABO blood groups and COVID-19 outcomes. (2) Methods: This retrospective study included 303 COVID-19 patients treated at the NMC Royal Hospital in the United Arab Emirates between 8 April 2020 and 30 June 2020. (3) Results: The mean age of patients included in the study was 39.3 ± 10.7 years, and 72.9% of patients were males. The prevalence of blood groups O, A, B, and AB was 40.3%, 27.7%, 25.1%, and 6.9%, respectively. The correlation between ABO blood groups and COVID-19 outcomes was insignificant except in the AB group, with significantly higher odds of disease severity. Increased age, higher body mass index (BMI), and being of male gender increased the risk for pneumonia among all blood groups. Both increased age and higher BMI increased the risk of mortality, and increased age increased the risk of disease severity. Troponin and platelet counts were significantly different in the A group compared to the non-A groups. Time to viral clearance was not different among blood groups. However, adjustment for Rh groups resulted in a significantly shorter time in the B group. (4) Conclusions: There was no significant association between ABO blood groups and COVID-19 outcomes, with the exception of group AB.
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Affiliation(s)
- Wael Hafez
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
- The Medical Research Division, Department of Internal Medicine, The National Research Center, Cairo 12622, Egypt
- Correspondence: ; Tel.: +971-2203-5000
| | - Shougyat Ahmed
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Nihad Abbas
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Kamran Ahmed
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Samera Kamran
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Arun Arya
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Srinivasa Raghu Rao
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Mahmoud Abdelshakor
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Sara Ali
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Honeymol Sebastian
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Mishal Tariq
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Kumar Lal
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
| | - Ahmed Abdelrahman
- NMC Royal Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates; (S.A.); (N.A.); (K.A.); (S.K.); (A.A.); (S.R.R.); (M.A.); (S.A.); (H.S.); (M.T.); (K.L.); (A.A.)
- Internal Medicine Department, Zagazig School of Medicine, Zagazig 44519, Egypt
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Tambat N, Mulani SK, Ahmad A, Shaikh SB, Ahmed K. Pyrazine Derivatives—Versatile Scaffold. Russ J Bioorg Chem 2022. [DOI: 10.1134/s1068162022050259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Haiser A, Aydin A, Kunduzi B, Ahmed K, Dasgupta P. A Systematic Review of Simulation-Based Training in Vascular Surgery. J Surg Res 2022; 279:409-419. [PMID: 35839575 PMCID: PMC9483723 DOI: 10.1016/j.jss.2022.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/20/2022] [Accepted: 05/22/2022] [Indexed: 11/25/2022]
Abstract
Introduction Recent advancements in surgical technology, reduced working hours, and training opportunities exacerbated by the COVID-19 pandemic have led to an increase in simulation-based training. Furthermore, a rise in endovascular procedures has led to a requirement for high-fidelity simulators that offer comprehensive feedback. This review aims to identify vascular surgery simulation models and assess their validity and levels of effectiveness (LoE) for each model in order to successfully implement them into current training curricula. Methods PubMed and EMBASE were searched on January 1, 2021, for full-text English studies on vascular surgery simulators. Eligible articles were given validity ratings based on Messick’s modern concept of validity alongside an LoE score according to McGaghie’s translational outcomes. Results Overall 76 eligible articles validated 34 vascular surgery simulators and training courses for open and endovascular procedures. High validity ratings were achieved across studies for: content (35), response processes (12), the internal structure (5), relations to other variables (57), and consequences (2). Only seven studies achieved an LoE greater than 3/5. Overall, ANGIO Mentor was the most highly validated and effective simulator and was the only simulator to achieve an LoE of 5/5. Conclusions Simulation-based training in vascular surgery is a continuously developing field with exciting future prospects, demonstrated by the vast number of models and training courses. To effectively integrate simulation models into current vascular surgery curricula and assessments, there is a need for studies to look at trainee skill retention over a longer period of time. A more detailed discussion on cost-effectiveness is also needed.
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Affiliation(s)
- Alexander Haiser
- Guy's, King's and St Thomas' School of Medical Education, King's College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.
| | - Basir Kunduzi
- Department of Transplant Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
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Eymech O, Brunckhorst O, Deacon M, James C, Bowie J, Dasgupta P, Ahmed K. The impact of radical prostatectomy on the social well-being of prostate cancer survivors: A qualitative meta-synthesis. Eur J Cancer Care (Engl) 2022; 31:e13630. [PMID: 35754206 DOI: 10.1111/ecc.13630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The impact of radical prostatectomy on the social well-being of survivors remains poorly understood. This meta-synthesis therefore aimed to integrate the findings of qualitative research evaluating the impact of surgery on the patient relationships with partners, family and wider societal interactions. METHODS Medline, CINAHL, PsycINFO and Embase were searched for qualitative studies evaluating social well-being dimensions. A thematic meta-synthesis was conducted to inductively construct descriptive themes and overarching analytical themes. RESULTS Thirty-one articles were included, with seven descriptive themes under two analytical themes generated to describe the experiences of 469 participants. 'Pathway to Conversion' encompassed three themes on the evolving social behaviour of men with both partners and family to adapt to their new normality postoperatively. 'A Man on My Own' discussed four themes focussing on both intimate and wider social relations, describing the stigma, shame and embarrassment felt by patients due to changes in their perceived body image and physical function. This resulted in men feeling alone, unsupported and seeking isolation. CONCLUSION Radical prostatectomy's impact on survivors' social well-being extends beyond surgery and causes a shift in their relationship dynamics with partner and family, highlighting the importance of preoperative and postoperative clinician's counselling to both patient and partner.
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Affiliation(s)
- Omar Eymech
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Matthew Deacon
- Department of Urology, King's College Hospital, London, UK
| | - Callum James
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Jessica Bowie
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.,Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.,Department of Urology, King's College Hospital, London, UK.,Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, UAE.,Khalifa University, Abu Dhabi, UAE
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Khan-Ruf S, Warren H, DhaRocca L, Ahmed K. Overcoming barriers for women entering the urology workforce in the United Kingdom. Journal of Clinical Urology 2022. [DOI: 10.1177/20514158221089418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Urology has considerable gender disparity with just 10.3% of UK consultant posts held by women and lower than the 13.2% average across all surgical specialties. Medicine is no longer a male-dominated vocation, with women making up the majority of medical graduates for almost 30 years. To recruit the highest calibre doctors, urology needs to appeal and be accessible to all talented individuals. Objective: In this paper we explore barriers to workforce diversity and propose solutions to the current problems. Methods: A literature review was conducted and authors’ opinions explored. Results: Reasons for women avoiding a career in urology include perceptions of urology as a ‘male’ specialty, lack of female role models, less mentoring and sponsorship of female medical students and trainees, and the use of derogatory and devaluing language. We suggest solutions to overcome these barriers for the benefit of profession. Conclusions: While there is a way to go to reach gender parity, there are reasons to be optimistic. We propose to see more women supported through mentoring programmes, more female representation on panels and in leadership positions to raise the profile of women in urology. We need to create a workplace culture and flexible working patterns that encourages all genders to excel.
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Eymech O, Brunckhorst O, Fox L, Jawaid A, Van Hemelrijck M, Stewart R, Dasgupta P, Ahmed K. An exploration of wellbeing in men diagnosed with prostate cancer undergoing active surveillance: a qualitative study. Support Care Cancer 2022; 30:5459-5468. [PMID: 35304633 PMCID: PMC8933126 DOI: 10.1007/s00520-022-06976-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE There is a growing emphasis on improving quality of life of people with prostate cancer. However, those undergoing active surveillance remain underrepresented in the literature with less known about their unique challenges. Therefore, we aimed to explore their lived experiences post diagnosis and its effect on their mental, social, and physical wellbeing. METHODS Qualitative semi-structured interviews were conducted with 13 men undergoing active surveillance for low-risk disease. Thematic analysis was used to inductively co-construct themes through the lens of the biopsychosocial model. RESULTS Mental wellbeing was strongly affected in our participants due to the overwhelming emotional impact of their diagnosis resulting in an 'Emotional Diagnostic Disequilibrium'. Informational awareness and education about prostate cancer helped patients with 'Recognition of the Impact'. Patients experienced an 'Unsettling Monitoring Cycle' due to the increased fear and anxiety around PSA monitoring appointments, with some men ignoring their mental wellbeing needs as their disease is 'A Future Problem'. 'Concealment of Diagnosis' left many feeling isolated and highlighted an important coping mechanisms in the 'Importance of a Social Support Network' theme. Finally, physical health mostly changed through alterations in health behaviour, leading to 'A Healthier Lifestyle' with increasing attribution of physical symptoms to age through 'Symptomatic Overshadowing'. CONCLUSION The greatest disease impact on men's wellbeing was at the time of diagnosis, with a subsequent cyclical anxiety and fear of disease progression prominent around monitoring appointments. Future research should explore ways to better support patients with these issues and at these times, improving their quality of life.
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Affiliation(s)
- Omar Eymech
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.
| | - Louis Fox
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Anam Jawaid
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
- Urology Centre, Guy's and St, Thomas' NHS Foundation Trust, King's Health Partners London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
- Department of Urology, King's College Hospital, London, UK
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Ahmed K, Breuer J, Huynh K, Abi-Jaoudeh N. Abstract No. 277 Racial disparity in acute pulmonary embolism treatment. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ali FR, Shoaib MH, Ali SA, Yousuf RI, Siddiqui F, Raja R, Jamal HS, Saleem MT, Ahmed K, Imtiaz MS, Ahmad M, Sarfaraz S, Ahmed FR. A nanoemulsion based transdermal delivery of insulin: Formulation development, optimization, in-vitro permeation across Strat-M® membrane and its pharmacokinetic/pharmacodynamic evaluation. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Weinfurtner RJ, Abdalah M, Stringfield O, Ataya D, Williams A, Mooney B, Rosa M, Lee MC, Khakpour N, Laronga C, Czerniecki B, Diaz R, Ahmed K, Washington I, Latifi K, Niell BL, Montejo M, Raghunand N. Quantitative Changes in Intratumoral Habitats on MRI Correlate With Pathologic Response in Early-stage ER/PR+ HER2- Breast Cancer Treated With Preoperative Stereotactic Ablative Body Radiotherapy. J Breast Imaging 2022; 4:273-284. [PMID: 36686407 PMCID: PMC9851176 DOI: 10.1093/jbi/wbac013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective To quantitatively evaluate intratumoral habitats on dynamic contrast-enhanced (DCE) breast MRI to predict pathologic breast cancer response to stereotactic ablative body radiotherapy (SABR). Methods Participants underwent SABR treatment (28.5 Gy x3), baseline and post-SABR MRI, and breast-conserving surgery for ER/PR+ HER2- breast cancer. MRI analysis was performed on DCE T1-weighted images. MRI voxels were assigned eight habitats based on high (H) or low (L) maximum enhancement and the sequentially numbered dynamic sequence of maximum enhancement (H1-4, L1-4). MRI response was analyzed by percent tumor volume remaining (%VR = volume post-SABR/volume pre-SABR), and percent habitat makeup (%HM of habitat X = habitat X voxels/total voxels in the segmented volume). These were correlated with percent tumor bed cellularity (%TC) for pathologic response. Results Sixteen patients completed the trial. The %TC ranged 20%-80%. MRI %VR demonstrated strong correlations with %TC (Pearson R = 0.7-0.89). Pre-SABR tumor %HMs differed significantly from whole breasts (P = 0.005 to <0.00001). Post-SABR %HM of tumor habitat H4 demonstrated the largest change, increasing 13% (P = 0.039). Conversely, combined %HM for H1-3 decreased 17% (P = 0.006). This change correlated with %TC (P < 0.00001) and distinguished pathologic partial responders (≤70 %TC) from nonresponders with 94% accuracy, 93% sensitivity, 100% specificity, 100% positive predictive value, and 67% negative predictive value. Conclusion In patients undergoing preoperative SABR treatment for ER/PR+ HER2- breast cancer, quantitative MRI habitat analysis of %VR and %HM change correlates with pathologic response.
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Affiliation(s)
| | - Mahmoud Abdalah
- Moffitt Cancer Center, Quantitative Imaging Core, Tampa, Fl, USA
| | - Olya Stringfield
- Moffitt Cancer Center, Quantitative Imaging Core, Tampa, Fl, USA
| | - Dana Ataya
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Angela Williams
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Blaise Mooney
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Marilin Rosa
- Moffitt Cancer Center, Department of Pathology, Tampa, FL, USA
| | - Marie C Lee
- Moffitt Cancer Center, Department of Surgery, Tampa, FL, USA
| | | | | | | | - Roberto Diaz
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Kamran Ahmed
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Iman Washington
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Kujtim Latifi
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Bethany L Niell
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Michael Montejo
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
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Abelleyra Lastoria DA, Raison N, Aydin A, Khan S, Dasgupta P, Ahmed K. Comparing surgical interventions for interstitial cystitis: A systematic review. Low Urin Tract Symptoms 2022; 14:218-241. [PMID: 35393778 DOI: 10.1111/luts.12441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/10/2022] [Accepted: 03/20/2022] [Indexed: 12/17/2022]
Abstract
The purpose of this review was to summarize and compare the efficacy among surgical interventions in terms of symptomatic relief in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). The review protocol was published on PROSPERO. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was followed. Following database search, a narrative synthesis was performed. Data pertaining symptom scores, pain levels, and voiding frequency following surgery were summarized by calculating percentage change in these parameters. Multiple surgical treatments were identified. These included injections of hyaluronic acid (HA), botulinum toxin A (Botox A), triamcinolone, resiniferatoxin (RTX), platelet-rich plasma, and 50% dimethyl sulfoxide (DMSO) solution, neuromodulation, hydrodistension (HD), resection/fulguration of Hunner lesions, resection of ilioinguinal and iliohypogastric nerves, reconstructive surgery, and cystectomy. This review found no evidence suggesting that HD and RTX injections can ameliorate IC/BPS symptoms. Current evidence suggests that sacral neuromodulation, cystectomy, and transurethral resection/fulguration of Hunner lesions could lead to symptomatic relief in IC/BPS. Further research into the efficacy of Botox A, triamcinolone, 50% DMSO solution, and HA instillations is required. However, the best treatment options cannot be reliably stated due to the low level of evidence of the studies identified. Further research should report outcomes for Hunner-type IC and BPS separately given their differing histopathological characteristics. Performing high-quality randomized controlled trials could be hindered by the low prevalence of the condition and a small proportion of patients progressing to surgery.
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Affiliation(s)
| | - Nicholas Raison
- Simulation Unit, MRC Centre for Transplantation, King's College London, London, UK
| | - Abdullatif Aydin
- Simulation Unit, MRC Centre for Transplantation, King's College London, London, UK
| | - Shamim Khan
- Simulation Unit, MRC Centre for Transplantation, King's College London, London, UK
| | - Prokar Dasgupta
- Simulation Unit, MRC Centre for Transplantation, King's College London, London, UK
| | - Kamran Ahmed
- Simulation Unit, MRC Centre for Transplantation, King's College London, London, UK
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Rubino S, Oliver DE, Tran ND, Vogelbaum MA, Forsyth PA, Yu HHM, Ahmed K, Etame AB. Improving Brain Metastases Outcomes Through Therapeutic Synergy Between Stereotactic Radiosurgery and Targeted Cancer Therapies. Front Oncol 2022; 12:854402. [PMID: 35311078 PMCID: PMC8924127 DOI: 10.3389/fonc.2022.854402] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 12/12/2022] Open
Abstract
Brain metastases are the most common form of brain cancer. Increasing knowledge of primary tumor biology, actionable molecular targets and continued improvements in systemic and radiotherapy regimens have helped improve survival but necessitate multidisciplinary collaboration between neurosurgical, medical and radiation oncologists. In this review, we will discuss the advances of targeted therapies to date and discuss findings of studies investigating the synergy between these therapies and stereotactic radiosurgery for non-small cell lung cancer, breast cancer, melanoma, and renal cell carcinoma brain metastases.
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Affiliation(s)
- Sebastian Rubino
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Daniel E Oliver
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Nam D Tran
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Michael A Vogelbaum
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Peter A Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | | | - Kamran Ahmed
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Arnold B Etame
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
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Velurajah R, Brunckhorst O, Waqar M, McMullen I, Ahmed K. Erectile dysfunction in patients with anxiety disorders: a systematic review. Int J Impot Res 2022; 34:177-186. [PMID: 33603242 PMCID: PMC8964411 DOI: 10.1038/s41443-020-00405-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 01/03/2023]
Abstract
Men with anxiety disorders have been identified as high risk of developing erectile dysfunction (ED). The aim of this review is to define the prevalence and severity of ED in the male anxiety disorder population. A literature search of three electronic databases (PubMed, Embase and PsychINFO) and a grey literature registry was conducted. Inclusion criteria were studies that investigated adult males, documented diagnosis of anxiety disorders made by a qualified psychiatrist and use of a validated tool to diagnose ED such as International Index of Erectile Function or ICD-10/DSM-IV. The search yielded 1220 articles and 12 studies were selected. The anxiety disorders investigated were post-traumatic stress disorder, obsessive-compulsive disorder, social phobia/social anxiety disorder and panic disorder. We found that the median [IQR] prevalence of ED was 20.0 [5.1-41.2]% and the median [IQR] International Index of Erectile Function-5 scores were 17.62 [13.88-20.88], indicating a mild to moderate severity. Our review suggests a high prevalence of ED in the anxiety disorder population and ED may be more severe in this cohort, therefore advocating this is an important clinical topic. However, the evidence is limited due to the high heterogeneity between the studies and more research is required in this field.
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Affiliation(s)
- Rajalaxmi Velurajah
- GKT School of Medicine, Department of Bioscience Education, King's College London, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Muhammad Waqar
- Department of Urology, King's College Hospital, London, UK
| | | | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.
- Department of Urology, King's College Hospital, London, UK.
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Kaul A, Katelaris A, Haider A, Freeman A, Ahmed K, Alnajjar HM, Muneer A. Microdissection oncoTESE (micro-oncoTESE) in azoospermic men with suspected testicular cancer: Analysis of outcomes from a specialist centre. Journal of Clinical Urology 2022. [DOI: 10.1177/20514158211073426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The main aim of this study was to report the outcomes of azoospermic men with suspicious testicular lesions, undergoing microsurgical sperm retrieval (micro-oncoTESE) at the time of radical/partial orchidectomy. Patients and methods: Testicular lesions suspicious for cancer were confirmed on ultrasound scanning. In patients undergoing radical inguinal orchidectomy, ex vivo microdissection of the unaffected testicular parenchyma was performed. Microdissection was performed in vivo for partial orchidectomy. The primary outcome measure was surgical sperm retrieval (SSR) rate. Results: A total of 33 patients (median age 33 years, interquartile range (IQR) 22) with suspected testicular cancer (TCa) underwent micro-oncoTESE. Histological analysis confirmed TCa in 26 patients and benign pathology in 7 patients. The overall SSR rate was 39%. Sub-analysis of patients with TCa and benign histology found that the SSR was 46% and 14%, respectively. There was no significant difference in maximum tumour length between successful and unsuccessful SSR groups 33.9 mm ± 23 (SD) versus 29.8 mm ± 17.5 (SD) ( p = 0.62). Conclusion: Based on our cohort, micro-oncoTESE provides an option for sperm retrieval in azoospermic men with testicular lesions.
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Affiliation(s)
- Asheesh Kaul
- Institute of Andrology, Department of Urology, University College London Hospital, UK
| | - Athos Katelaris
- Institute of Andrology, Department of Urology, University College London Hospital, UK
| | - Aiman Haider
- Department of Pathology, University College London Hospital, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital, UK
| | - Kamran Ahmed
- Institute of Andrology, Department of Urology, University College London Hospital, UK
| | - Hussain M Alnajjar
- Institute of Andrology, Department of Urology, University College London Hospital, UK
| | - Asif Muneer
- Institute of Andrology, Department of Urology, University College London Hospital, UK
- NIHR Biomedical Research Centre, University College London Hospital, UK
- Division of Surgery and Interventional Science, University College London, UK
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James C, Brunckhorst O, Eymech O, Stewart R, Dasgupta P, Ahmed K. Fear of cancer recurrence and PSA anxiety in patients with prostate cancer: a systematic review. Support Care Cancer 2022; 30:5577-5589. [PMID: 35106656 PMCID: PMC9135793 DOI: 10.1007/s00520-022-06876-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/27/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE The impact of prostate cancer on the mental wellbeing of patients is increasingly being appreciated. Two important aspects of this include fear of cancer recurrence (FCR) and prostate-specific antigen (PSA) anxiety. However, their prevalence, severity and associating factors remain poorly understood. Therefore, this review aims to evaluate the current evidence for the prevalence, severity and associating features of PSA anxiety and FCR. METHODS A systematic search of MEDLINE, EMBASE and PsycINFO databases was conducted by two independent reviewers. Observational studies measuring FCR and PSA anxiety in prostate cancer using validated measures were included. Outcome measures were prevalence of significant levels, mean scores and significant correlations of FCR and PSA anxiety scores with patient, disease, treatment or other mental health and quality of life outcomes. RESULTS One thousand one hundred forty-eight individual records underwent screening with 32 studies included. Median prevalence of significant FCR and PSA anxiety was 16% and 22% respectively across all studies. Longitudinal studies demonstrated severity of both symptoms peaks at diagnosis, with little variability, even several years following this. Evaluating associating factors revealed younger age, generalised quality of life and mental health symptoms to be important factors for both outcomes. Few studies evaluated associations and differences between other patient, disease and treatment characteristics. CONCLUSION FCR and PSA anxiety are prominent symptoms for prostate cancer patients and importantly when present, are associated with poorer quality of life and mental health symptoms. Screening for these constructs and referral to appropriate services should form part of routine follow-up care.
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Affiliation(s)
- Callum James
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK.
| | - Omar Eymech
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Robert Stewart
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK.,Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK.,Department of Urology, King's College Hospital, London, UK
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